Pediatric IHCA with ECPR: ECMO delay is tied to mortality

  • Bembea MM & al.
  • Crit Care Med
  • 4 Feb 2019

  • curated by Jenny Blair, MD
  • Clinical Essentials
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • Children experiencing cardiac arrest who undergo extracorporeal cardiopulmonary resuscitation (ECPR) have higher mortality if extracorporeal membrane oxygenation (ECMO) is delayed.

Why this matters

  • In 2015 American Heart Association (AHA) guidelines, evidence was insufficient to recommend or discourage routine ECMO during ECPR for children with noncardiac diagnoses experiencing in-hospital cardiac arrest (IHCA).  
  • ECPR is considered reasonable in children with cardiac diagnoses not achieving quick return of spontaneous circulation (ROSC), according to 2018 AHA recommendations. 
  • Still unknown:
    • Long-term outcomes for survivors; 
    • Influence of prearrest illness(es) on ECPR outcomes; 
    • Associations of outcomes with CPR quality; ECPR location, equipment, personnel, and center characteristics; and
    • Effects of neuroprotective strategies during ECPR.

Key results

  • Overall in-hospital mortality: 59.4%.
  • Factors predicting death (aORs; 95% CIs): 
    • Noncardiac diagnoses: 1.85 (1.19-2.89),
    • Renal insufficiency: 4.74 (2.06-10.9),
    • 5-minute increase from CPR onset to ECMO initiation: 1.04 (1.01-1.07), and
    • 2 adverse events during ECMO: 1.75 (1.023-2.995); aOR rose further with each additional event.

Study design

  • Analysis of 2 prospective registries, 2000-2014: Extracorporeal Life Support Organization and American Heart Association Get With the Guidelines-Resuscitation (n=593).
  • Authors sought factors predicting in-hospital mortality after ECPR for pediatric in-hospital cardiac arrest. 
  • Funding: NIH.

Limitations

  • Possible unmeasured confounders.

Please confirm your acceptance

To gain full access to GPnotebook please confirm:

By submitting here you confirm that you have accepted Terms of Use and Privacy Policy of GPnotebook.

Submit