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Pediatric Extracorporeal Cardiopulmonary Resuscitation: A Systematic Review
Ivie D Esangbedo1,2, Marissa A Brunetti3,4, Frank M Campbell5
1Division of Pediatric Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
Insights
Pediatric extracorporeal cardiopulmonary resuscitation (ECPR) use is primarily documented in retrospective studies of in-hospital cardiac arrest, particularly in cardiac patients. Survival rates vary widely, and more prospective research is needed to establish best practices.
Area of Science:
- Pediatric Critical Care Medicine
- Cardiovascular Surgery
- Emergency Medicine
Background:
- Extracorporeal cardiopulmonary resuscitation (ECPR) is an advanced life support technique utilized in pediatric patients experiencing cardiac arrest.
- The existing literature on pediatric ECPR is predominantly composed of retrospective, single-center studies, often focusing on in-hospital cardiac arrest scenarios.
Purpose of the Study:
- To systematically review and synthesize the available literature on pediatric ECPR.
- To delineate current utilization patterns, clinical practices, and patient outcomes associated with pediatric ECPR.
- To identify knowledge gaps and inform future research directions in the field.
Main Methods:
- A comprehensive systematic review was conducted using multiple databases (PubMed, Embase, Scopus, Cochrane Library, ClinicalTrials.gov).
- The search included all publication years for peer-reviewed original research on pediatric ECPR (patients < 18 years).
- Studies were assessed for inclusion using PRISMA methodology, with risk of bias evaluated using the ROBINS-I tool.
Main Results:
- No randomized controlled trials were identified for pediatric ECPR.
- The majority of included studies were retrospective, focusing on in-hospital cardiac arrest, with a significant proportion involving pediatric cardiac patients.
- Reported survival to hospital discharge for pediatric in-hospital cardiac arrest ranged from 8% to 80%, with improved outcomes noted in cardiac patients.
- Neurologic outcomes were reported in 31 studies, but only six utilized prospective follow-up.
Conclusions:
- Significant heterogeneity exists in pediatric ECPR practices and outcomes, with limited high-quality evidence.
- There is a critical need for standardized protocols, prospective studies, and research into optimal candidacy, timing, staffing, and cannulation strategies for pediatric ECPR.
- The findings highlight substantial gaps in understanding best practices and provide a framework for future research to improve pediatric ECPR care.
Objectives:
This systematic review aims to summarize the body of available literature on pediatric extracorporeal cardiopulmonary resuscitation in order to delineate current utilization, practices, and outcomes, while highlighting gaps in current knowledge.
Data Sources:
PubMed, Embase, Scopus, Cochrane Library, and ClinicalTrials.gov databases.
Study Selection:
We searched for peer-reviewed original research publications on pediatric extracorporeal cardiopulmonary resuscitation (patients < 18 yr old) and were inclusive of all publication years.
Data Extraction:
Our systematic review used the structured Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. Our initial literature search was performed on February 11, 2019, with an updated search performed on August 28, 2019. Three physician reviewers independently assessed the retrieved studies to determine inclusion in the systematic review synthesis. Using selected search terms, a total of 4,095 publications were retrieved, of which 96 were included in the final synthesis. Risk of bias in included studies was assessed using the Risk of Bias in Non-Randomized Studies of Interventions-I tool.
Data Synthesis:
There were no randomized controlled trials of extracorporeal cardiopulmonary resuscitation use in pediatrics. A vast majority of pediatric extracorporeal cardiopulmonary resuscitation publications were single-center retrospective studies reporting outcomes after in-hospital cardiac arrest. Most pediatric extracorporeal cardiopulmonary resuscitation use in published literature is in cardiac patients. Survival to hospital discharge after extracorporeal cardiopulmonary resuscitation for pediatric in-hospital cardiac arrest ranged from 8% to 80% in included studies, and there was an association with improved outcomes in cardiac patients. Thirty-one studies reported neurologic outcomes after extracorporeal cardiopulmonary resuscitation, of which only six were prospective follow-up studies. We summarize the available literature on: determination of candidacy, timing of activation of extracorporeal cardiopulmonary resuscitation, staffing/logistics, cannulation strategies, outcomes, and the use of simulation for training.
Conclusions:
This review highlights gaps in our understanding of best practices for pediatric extracorporeal cardiopulmonary resuscitation. We summarize current studies available and provide a framework for the development of future studies.
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