- 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.
- 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.
- 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.
- Possible unmeasured confounders.