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Pediatric Animal Model of Extracorporeal Cardiopulmonary Resuscitation After Prolonged Circulatory Arrest
Published on: May 26, 2023
Extracorporeal-Cardiopulmonary Resuscitation Deployment in the Pediatric Emergency Department Setting: 2000-2023
Gurpreet S Dhillon1, Tia T Raymond2, Aarti C Bavare3
1Department of Pediatrics, Division of Cardiology, Lucile Packard Children's Hospital at Stanford Medical Center, Stanford, CA.
Insights
Extracorporeal cardiopulmonary resuscitation (E-CPR) for pediatric in-hospital cardiac arrest (IHCA) in the emergency department (ED) is rare, with one-third survival. Underlying cardiac conditions improved outcomes in this population.
Area of Science:
- Pediatric Critical Care Medicine
- Emergency Medicine
- Cardiovascular Research
Background:
- Pediatric in-hospital cardiac arrest (IHCA) leading to extracorporeal cardiopulmonary resuscitation (E-CPR) typically occurs in the ICU, primarily in cardiac patients.
- Limited data exists on E-CPR utilization for pediatric IHCA within the emergency department (ED).
Purpose of the Study:
- To describe the characteristics and outcomes of pediatric patients undergoing E-CPR for IHCA in the ED.
- To identify factors associated with survival in this specific patient group.
Main Methods:
- Retrospective analysis of the American Heart Association's Get With the Guidelines-Resuscitation (GWTG-R) registry (2000-2023).
- Inclusion criteria: Children (<18 years) experiencing IHCA in the ED with E-CPR deployment for return of circulation (ROC), categorized by cardiac and noncardiac diagnoses.
- Data collected on initial rhythms, CPR duration, interventions, and survival to discharge.
Main Results:
- 51 pediatric patients received E-CPR for IHCA in the ED.
- Pulseless electrical activity was the most common initial rhythm (52%).
- Overall survival to discharge was 33.3%. Survival was higher in patients with underlying cardiac conditions (p=0.025) and associated with lower IV calcium use (p=0.01).
Conclusions:
- E-CPR for pediatric IHCA in the ED is infrequently reported, with approximately one-third survival.
- Underlying cardiac diagnosis is associated with improved ROC and survival.
- Further research is warranted to optimize E-CPR use in the ED and identify potential missed opportunities.
Objectives:
Pediatric in-hospital cardiac arrest (IHCA) events leading to extracorporeal cardiopulmonary resuscitation (E-CPR) most often occur in the ICU in cardiac patients. Since there is little information about using E-CPR for pediatric IHCA in the emergency department (ED), we aimed to describe this population.
Design:
The American Heart Association's Get With the Guidelines-Resuscitation (GWTG-R) registry of pediatric IHCA, 2000-2023, a retrospective study.
Setting:
EDs in hospitals contributing to the GWTG-R registry.
Patients:
Children less than 18 years old experiencing index IHCA events in the ED where E-CPR was deployed to achieve return of circulation (ROC). Only cardiac and noncardiac illness categories were included.
Interventions:
None.
Measurements And Main Results:
We identified 51 children with a median (interquartile range [IQR]) age of 2 years (IQR, 0.3-5 yr). Pulseless electrical activity was the initial pulseless rhythm in 24 of 46 patients (52%), and pulseless ventricular tachycardia in four of 46 patients (9%). Median CPR duration was 68 minutes (IQR, 48-92 min), with a median number of epinephrine doses being 12 (IQR, 7-19). Nonsurvival vs. survival was associated with greater use of IV calcium (28/30 vs. 8/12; difference 35% [95% CI, 8.2-58.2%]; p = 0.01). Overall survival was 17 of 51 (33.3% [95% CI, 22.0-47.0%]). Cardiac, as opposed to noncardiac underlying diagnosis, was associated with a higher percentage of successful E-CPR with ROC (26/27 vs. 18/24; difference, 21% [95% CI, 1.8-45%]; p = 0.025).
Conclusions:
In the GWTG-R registry of pediatric IHCA, covering 23 years, E-CPR deployment for IHCA in the ED was reported 51 times. Overall survival to discharge occurred in one-third of cases. We also noted that an underlying cardiac disorder was associated with higher proportions achieving ROC and discharge survival. Further studies are needed to better understand this population and see whether there are missed opportunities in the ED, beyond the median of one case per year, when E-CPR could have been deployed.
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