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Optimizing patient selection for ECMO after pediatric hypothermic cardiac arrest
Jack H Scaife1, Hilary A Hewes2, Stephanie E Iantorno1
1Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA.
Injury
|July 24, 2024
Summary
The HOPE score may help select pediatric patients for extracorporeal membrane oxygenation (ECMO) after hypothermic cardiac arrest. Applying this score could reduce unnecessary ECMO cannulations while preserving survival rates in children.
Area of Science:
- Pediatric Critical Care Medicine
- Cardiopulmonary Support
- Emergency Medicine
Background:
- Established ECMO protocol for pediatric hypothermic cardiac arrest since 2004.
- Adult hypothermic cardiac arrest survival prediction model (HOPE score) lacks pediatric validation.
Purpose of the Study:
- To validate the HOPE score in a pediatric population.
- To assess the HOPE score's utility in optimizing patient selection for ECMO.
Main Methods:
- Retrospective review of pediatric patients on VA ECMO for hypothermic cardiac arrest (2004-2022).
- Calculation of HOPE scores with and without presumed asphyxia.
Main Results:
- 18 patients cannulated over 19 years; 3 survivors (17%).
- HOPE score ranges varied significantly with and without presumed asphyxia.
- A HOPE score cutoff >5% (with asphyxia) could have halved cannulations without missing survivors.
Conclusions:
- ECMO is life-saving for select pediatric hypothermic arrest patients.
- Identifying optimal candidates for ECMO remains challenging.
- HOPE score may reduce futile cannulations in children; multi-center studies are needed.
Keywords:
Cardiac surgical proceduresExtracorporeal membrane oxygenationSurvival rateTreatment outcomesMore Related Videos
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