Duration of resuscitation prior to rescue extracorporeal membrane oxygenation impacts outcome in children with heart disease

Abstract

Purpose: Survival outcomes in children with heart disease after use of either non-emergent extracorporeal membrane oxygenation (ECMO) or cardiopulmonary resuscitation (CPR) onto ECMO (ECPR) are comparable. Concerns remain regarding the impact of CPR duration on survival and neurological outcome.

Methods: Children with cardiac disease requiring ECMO were identified from our database. Demographic, operative and ECMO details were evaluated with respect to survival. In addition, resuscitation details were extracted for the recent subgroup requiring ECPR; these details were evaluated with respect to survival and neurological outcomes at midterm follow-up by univariate analysis and multivariable logistic regression.

Results: There were 126 ECMO runs in 116 children; 61 (53%) received ECPR. Forty-eight (41%) children survived to discharge; survival in the most recent era was 48%. Thirty-seven children underwent ECPR in the most recent era with 14 (38%) surviving to discharge. Duration of cardiopulmonary resuscitation differed significantly between survivors and nonsurvivors (15 vs. 40 min, p = 0.009); children requiring ≥30 min of CPR had 79% reduced odds of hospital survival (OR = 0.21, 95% CI = 0.05-0.96, p = 0.04). Two children died after hospital discharge; with 33% having paediatric cerebral performance category scores ≤2. Poor neurological outcome was associated with longer duration of CPR (32 vs. 17.5 min, p = 0.03).

Conclusions: Despite comparable survival outcomes between ECPR and non-emergent ECMO in children with cardiac disease a significant association between CPR duration and outcome (survival and neurological) was noted in this population.