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Multicenter Study
. 2024 Apr 1;52(4):551-562.
doi: 10.1097/CCM.0000000000006153. Epub 2023 Dec 29.

Outcomes of Extracorporeal Cardiopulmonary Resuscitation for In-Hospital Cardiac Arrest Among Children With Noncardiac Illness Categories

Morgann Loaec  1   2 , Adam S Himebauch  1   2 , Ron Reeder  3 , Jessica S Alvey  3 , Jonathan A Race  3 , Lillian Su  4 , Javier J Lasa  5 , Julia C Slovis  1   2 , Tia T Raymond  6 , Ryan Coleman  7 , Bradley J Barney  3 , Todd J Kilbaugh  1   2 , Alexis A Topjian  1   2 , Robert M Sutton  1   2 , Ryan W Morgan  1   2 ; American Heart Association’s (AHA) Get With The Guidelines-Resuscitation (GWTG-R) Investigators
Collaborators, Affiliations
Multicenter Study

Outcomes of Extracorporeal Cardiopulmonary Resuscitation for In-Hospital Cardiac Arrest Among Children With Noncardiac Illness Categories

Morgann Loaec et al. Crit Care Med. .

Abstract

Objectives: The objective of this study was to determine the association of the use of extracorporeal cardiopulmonary resuscitation (ECPR) with survival to hospital discharge in pediatric patients with a noncardiac illness category. A secondary objective was to report on trends in ECPR usage in this population for 20 years.

Design: Retrospective multicenter cohort study.

Setting: Hospitals contributing data to the American Heart Association's Get With The Guidelines-Resuscitation registry between 2000 and 2021.

Patients: Children (<18 yr) with noncardiac illness category who received greater than or equal to 30 minutes of cardiopulmonary resuscitation (CPR) for in-hospital cardiac arrest.

Interventions: None.

Measurements and main results: Propensity score weighting balanced ECPR and conventional CPR (CCPR) groups on hospital and patient characteristics. Multivariable logistic regression incorporating these scores tested the association of ECPR with survival to discharge. A Bayesian logistic regression model estimated the probability of a positive effect from ECPR. A secondary analysis explored temporal trends in ECPR utilization. Of 875 patients, 159 received ECPR and 716 received CCPR. The median age was 1.0 [interquartile range: 0.2-7.0] year. Most patients (597/875; 68%) had a primary diagnosis of respiratory insufficiency. Median CPR duration was 45 [35-63] minutes. ECPR use increased over time ( p < 0.001). We did not identify differences in survival to discharge between the ECPR group (21.4%) and the CCPR group (16.2%) in univariable analysis ( p = 0.13) or propensity-weighted multivariable logistic regression (adjusted odds ratio 1.42 [95% CI, 0.84-2.40; p = 0.19]). The Bayesian model estimated an 85.1% posterior probability of a positive effect of ECPR on survival to discharge.

Conclusions: ECPR usage increased substantially for the last 20 years. We failed to identify a significant association between ECPR and survival to hospital discharge, although a post hoc Bayesian analysis suggested a survival benefit (85% posterior probability).

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Conflict of interest statement

The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Patient selection flow diagram of sequential exclusions of patients included in the final cohort separated by extracorporeal cardiopulmonary resuscitation (ECPR) vs. conventional CPR (CCPR) status. PCPC = pediatric cerebral performance category, ROC = return of circulation.
Figure 2.
Figure 2.
Percentage of pediatric patients with a noncardiac illness category receiving greater than or equal to 30min of cardiopulmonary resuscitation (CPR) for in-hospital cardiac arrests who received treatment with extracorporeal CPR (ECPR) out of all the CPR events in this cohort by event year.
See this image and copyright information in PMC

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