. 2024 Apr 1;25(4):312-322.

doi: 10.1097/PCC.0000000000003423. Epub 2023 Dec 13.

Early Cardiac Arrest Hemodynamics, End-Tidal C o2 , and Outcome in Pediatric Extracorporeal Cardiopulmonary Resuscitation: Secondary Analysis of the ICU-RESUScitation Project Dataset (2016-2021)

Andrew R Yates¹, Maryam Y Naim², Ron W Reeder³, Tageldin Ahmed⁴, Russell K Banks³, Michael J Bell⁵, Robert A Berg², Robert Bishop⁶, Matthew Bochkoris⁷, Candice Burns⁸, Joseph A Carcillo⁷, Todd C Carpenter⁶, J Michael Dean³, J Wesley Diddle⁵, Myke Federman⁹, Richard Fernandez¹, Ericka L Fink⁷, Deborah Franzon¹⁰, Aisha H Frazier^{11

12}, Stuart H Friess¹³, Kathryn Graham², Mark Hall¹, David A Hehir², Christopher M Horvat⁷, Leanna L Huard⁹, Tensing Maa¹, Arushi Manga¹³, Patrick S McQuillen¹⁰, Ryan W Morgan², Peter M Mourani¹⁴, Vinay M Nadkarni², Daniel Notterman¹⁵, Murray M Pollack⁵, Anil Sapru⁹, Carleen Schneiter⁶, Matthew P Sharron⁵, Neeraj Srivastava⁹, Bradley Tilford⁴, Shirley Viteri¹⁶, David Wessel⁵, Heather A Wolfe², Justin Yeh⁷, Athena F Zuppa², Robert M Sutton², Kathleen L Meert⁴

Affiliations

¹ Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH.
² Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
³ Department of Pediatrics, University of Utah, Salt Lake City, UT.
⁴ Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI.
⁵ Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC.
⁶ Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO.
⁷ Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA.
⁸ Department of Pediatrics and Human Development, Michigan State University, Grand Rapids, MI.
⁹ Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA.
¹⁰ Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA.
¹¹ Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE.
¹² Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.
¹³ Department of Pediatrics, Washington University School of Medicine, St. Louis, MO.
¹⁴ Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's research Institute, Little Rock, AR.
¹⁵ Department of Molecular Biology, Princeton University, Princeton, NJ.
¹⁶ Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children and Thomas Jefferson University, Wilmington, DE.

PMID: 38088765
PMCID: PMC10994777
DOI: 10.1097/PCC.0000000000003423

Early Cardiac Arrest Hemodynamics, End-Tidal C o2 , and Outcome in Pediatric Extracorporeal Cardiopulmonary Resuscitation: Secondary Analysis of the ICU-RESUScitation Project Dataset (2016-2021)

Andrew R Yates et al. Pediatr Crit Care Med. 2024.

. 2024 Apr 1;25(4):312-322.

doi: 10.1097/PCC.0000000000003423. Epub 2023 Dec 13.

Authors

Affiliations

¹ Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH.
² Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
³ Department of Pediatrics, University of Utah, Salt Lake City, UT.
⁴ Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI.
⁵ Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine, Washington, DC.
⁶ Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO.
⁷ Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA.
⁸ Department of Pediatrics and Human Development, Michigan State University, Grand Rapids, MI.
⁹ Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA.
¹⁰ Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA.
¹¹ Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE.
¹² Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.
¹³ Department of Pediatrics, Washington University School of Medicine, St. Louis, MO.
¹⁴ Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's research Institute, Little Rock, AR.
¹⁵ Department of Molecular Biology, Princeton University, Princeton, NJ.
¹⁶ Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children and Thomas Jefferson University, Wilmington, DE.

PMID: 38088765
PMCID: PMC10994777
DOI: 10.1097/PCC.0000000000003423

Abstract

Objectives: Cannulation for extracorporeal membrane oxygenation during active extracorporeal cardiopulmonary resuscitation (ECPR) is a method to rescue patients refractory to standard resuscitation. We hypothesized that early arrest hemodynamics and end-tidal C o2 (ET co2 ) are associated with survival to hospital discharge with favorable neurologic outcome in pediatric ECPR patients.

Design: Preplanned, secondary analysis of pediatric Utstein, hemodynamic, and ventilatory data in ECPR patients collected during the 2016-2021 Improving Outcomes from Pediatric Cardiac Arrest study; the ICU-RESUScitation Project (ICU-RESUS; NCT02837497).

Setting: Eighteen ICUs participated in ICU-RESUS.

Patients: There were 97 ECPR patients with hemodynamic waveforms during cardiopulmonary resuscitation.

Interventions: None.

Measurements and main results: Overall, 71 of 97 patients (73%) were younger than 1 year old, 82 of 97 (85%) had congenital heart disease, and 62 of 97 (64%) were postoperative cardiac surgical patients. Forty of 97 patients (41%) survived with favorable neurologic outcome. We failed to find differences in diastolic or systolic blood pressure, proportion achieving age-based target diastolic or systolic blood pressure, or chest compression rate during the initial 10 minutes of CPR between patients who survived with favorable neurologic outcome and those who did not. Thirty-five patients had ET co2 data; of 17 survivors with favorable neurologic outcome, four of 17 (24%) had an average ET co2 less than 10 mm Hg and two (12%) had a maximum ET co2 less than 10 mm Hg during the initial 10 minutes of resuscitation.

Conclusions: We did not identify an association between early hemodynamics achieved by high-quality CPR and survival to hospital discharge with favorable neurologic outcome after pediatric ECPR. Candidates for ECPR with ET co2 less than 10 mm Hg may survive with favorable neurologic outcome.

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Conflict of interest statement

Drs. Yates’s, Naim’s, Reeder’s, Berg’s, Carpenter’s, Dean’s, Fink’s, Frazier’s, Hall’s, Manga’s, Mourani’s, Sapru’s, Wessel’s, Wolfe’s, Zuppa’s, and Meert’s institution received funding from the National Institutes of Health (NIH). Drs. Yates, Naim, Reeder, Banks, Berg, Carcillo, Carpenter, Dean, Fink, Franzon, Frazier, Freiss, Hall, Horvat, McQuillen, Mourani, Pollack, Sapru, Schneiter, Wessel, Zuppa, Sutton, and Meert received support for article research from the NIH. Drs. Banks’s, Carcillo’s, Horvat’s, Maa’s, McQuillen’s, Pollack’s, and Schneiter’s institutions received funding from the National Institute for Child Health and Human Development. Dr. Banks disclosed government work. Drs. Carcillo’s, Maa’s, and Sutton’s institutions received funding from the National Heart, Lung, and Blood Institute (NHLBI). Dr. Carcillo’s institution received funding from the National Institute for General Medical Sciences. Dr. Diddle disclosed that he is a consultant with Mallinckrodt Pharmaceuticals. Dr. Franzon received funding from Health Navigator Foundation; she disclosed that she is a site investigator for a multisite NIH funded project. Dr. Frazier’s institution received funding from the Neurocritical Care Society and the American Board of Pediatrics. Dr. Hall received funding from AbbVie, Kiadis, and the American Board of Pediatrics. Dr. Morgan’s institution received funding from the NHLBI (K23HL148541). Dr. Wolfe received funding from The Debriefing Academy. The remaining authors have disclosed that they do not have any potential conflicts of interest.

References

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1. Farhat A, Ling RR, Jenks CL, et al., Outcomes of Pediatric Extracorporeal Cardiopulmonary Resuscitation: A Systematic Review and Meta-Analysis. Crit Care Med, 2021. 49(4): p. 682–692. - PubMed
1. Nguyen DA, De Mul A, Hoskote AU, et al., Factors Associated With Initiation of Extracorporeal Cardiopulmonary Resuscitation in the Pediatric Population: An International Survey. ASAIO J, 2022. 68(3): p. 413–418. - PubMed
1. Yates AR, Sutton RM, Reeder RW, et al., Survival and Cardiopulmonary Resuscitation Hemodynamics Following Cardiac Arrest in Children With Surgical Compared to Medical Heart Disease. Pediatr Crit Care Med, 2019. 20(12): p. 1126–1136. - PMC - PubMed
1. Berg RA, Sutton RM, Reeder RW, et al., Association Between Diastolic Blood Pressure During Pediatric In-Hospital Cardiopulmonary Resuscitation and Survival. Circulation, 2018. 137(17): p. 1784–1795. - PMC - PubMed

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Early Cardiac Arrest Hemodynamics, End-Tidal C o2 , and Outcome in Pediatric Extracorporeal Cardiopulmonary Resuscitation: Secondary Analysis of the ICU-RESUScitation Project Dataset (2016-2021)

Affiliations

Early Cardiac Arrest Hemodynamics, End-Tidal C o2 , and Outcome in Pediatric Extracorporeal Cardiopulmonary Resuscitation: Secondary Analysis of the ICU-RESUScitation Project Dataset (2016-2021)

Authors

Affiliations

Abstract

Conflict of interest statement

References

MeSH terms

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Grants and funding

LinkOut - more resources

Full Text Sources

Medical