Extracorporeal cardiopulmonary resuscitation outcomes for children with out-of-hospital and emergency department cardiac arrest

Kyle S Bilodeau; Kristen E Gray; D Michael McMullan

doi:10.1016/j.ajem.2024.03.035

Extracorporeal cardiopulmonary resuscitation outcomes for children with out-of-hospital and emergency department cardiac arrest

Am J Emerg Med. 2024 Apr 7:81:35-39. doi: 10.1016/j.ajem.2024.03.035. Online ahead of print.

Authors

Kyle S Bilodeau¹, Kristen E Gray², D Michael McMullan³

Affiliations

¹ University of Washington, Department of General Surgery, Seattle, WA, United States of America.
² VA Puget Sound Health Care System, Health Services Research and Development, Seattle, WA, United States of America; University of Washington, Department of Health Systems and Population Health, Seattle, WA, United States of America.
³ Seattle Children's Hospital, Division of Cardiac Surgery, Seattle, WA, United States of America. Electronic address: michael.mcmullan@seattlechildrens.org.

PMID: 38657347
DOI: 10.1016/j.ajem.2024.03.035

Abstract

Objective: Data suggest extracorporeal cardiopulmonary resuscitation (ECPR) improves survival in adult patients with refractory cardiac arrest; however, ECPR outcomes in pediatric patients with out-of-hospital cardiac arrest (OHCA) is lacking. The primary aim of this study was to characterize pediatric patients who experience OHCA or cardiac arrest in the ED (EDCA). The secondary aim was to examine associations of cardiac arrest and location of ECPR cannulation with mortality.

Methods: We performed a retrospective analysis of the Extracorporeal Life Support Organization registry. We included pediatric patients (age > 28 days to <18 years) who received ECPR for refractory OHCA or EDCA between 2010 and 2019. Patient, cardiac arrest, and ECPR cannulation characteristics were summarized. We examined associations of location of cardiac arrest and ECPR cannulation with in-hospital mortality using multivariable logistic regression.

Results: We analyzed data from 140 pediatric patients. 66 patients (47%) experienced OHCA and 74 patients (53%) experienced EDCA. Overall survival to hospital discharge was 31% (20% OHCA survival vs. 41% EDCA survival, p = 0.008). In adjusted analyses, OHCA was associated with 3.9 times greater odds of mortality (95% confidence interval [CI] 1.61, 9.81) when compared to compared to EDCA. The location of ECPR cannulation was not associated with mortality (odds ratio 1.8, 95% CI 0.75, 4.3).

Conclusions: The use of ECPR for pediatric patients with refractory OHCA is associated with poor survival compared to patients with EDCA. Location of ECPR cannulation does not appear to be associated with mortality.

Keywords: Extracorporeal cardiopulmonary resuscitation; Extracorporeal membrane oxygenation; Pediatric emergency department cardiac arrest; Pediatric out-of-hospital cardiac arrest.