Factors Associated With Initiation of Extracorporeal Cardiopulmonary Resuscitation in the Pediatric Population: An International Survey

Nguyen, Duy-Anh; Mul, Aurélie De; Hoskote, Aparna; Cogo, Paola; Cruz, Eduardo M. da; Erickson, Simon; Lasa, Javier J.; Thiagarajan, Ravi R.; Bembea, Melania M.; Karam, Oliver

doi:10.1097/mat.0000000000001495

Cited by 11 publications

(8 citation statements)

References 23 publications

(44 reference statements)

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“…In a 2018 survey of neonatologists and ECMO medical directors, Weems et al (15) reported a higher proportion of providers willing to offer ECMO support in the setting of neonatal encephalopathy compared with a prior 2008 survey by Chapman et al (35). Last, an international survey conducted in 2020 showed that pre-existing neurologic delay was a factor moderately (as opposed to strongly) decreasing the likelihood of initiating ECMO during cardiac arrest (ECPR) (36). These studies demonstrate broadening of ECMO eligibility criteria over time, likely due to general factors such as increased availability and experience with ECMO, as well as potentially due to advancements in neuroprotective therapies (e.g., therapeutic hypothermia for neonatal encephalopathy).…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation Outcomes in Children With Preexisting Neurologic Disorders or Neurofunctional Disability*

Dante

Carroll

et al. 2022

Pediatric Critical Care Medicine

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Patient selection for pediatric extracorporeal membrane oxygenation (ECMO) support has broadened over the years to include children with preexisting neurologic morbidities. We aimed to determine the prevalence and nature of pre-ECMO neurologic disorders or disability and investigate the association between pre-ECMO neurologic disorders or disability and mortality and unfavorable neurologic outcome. DESIGN:Multicenter retrospective observational cohort study. SETTING:Eight hospitals reporting to the Pediatric ECMO Outcomes Registry between October 2011 and June 2019. PATIENTS:Children younger than 18 years supported with venoarterial or venovenous ECMO. INTERVENTIONS:The primary exposure was presence of pre-ECMO neurologic disorders or moderate-to-severe disability, defined as Pediatric Cerebral Performance Category (PCPC) or Pediatric Overall Performance Category (POPC) 3-5. The primary outcome was unfavorable outcome at hospital discharge, defined as in-hospital mortality or survival with moderate-to-severe disability (discharge PCPC 3-5 with deterioration from baseline). MEASUREMENTS AND MAIN RESULTS:Of 598 children included in the final cohort, 68 of 598 (11%) had a pre-ECMO neurologic disorder, 70 of 595 (12%) had a baseline PCPC 3-5, and 189 of 592 (32%) had a baseline POPC 3-5. The primary outcome of in-hospital mortality (n = 267) or survival with PCPC 3-5 with deterioration from baseline (n = 39) was observed in 306 of 598 (51%). Overall, one or more pre-ECMO neurologic disorders or disability were present in 226 of 598 children (38%) but, after adjustment for age, sex, diagnostic category, pre-ECMO cardiac arrest, and ECMO mode, were not independently associated with increased odds of unfavorable outcome (unadjusted odds ratio [OR], 1.34; 95% CI, 1.07-1.69; multivariable adjusted OR, 1.30; 95% CI, 0.92-1.82). CONCLUSIONS:In this exploratory study using a multicenter pediatric ECMO registry, more than one third of children requiring ECMO support had pre-ECMO neurologic disorders or disability. However, pre-existing morbidities were not independently associated with mortality or unfavorable neurologic outcomes at hospital discharge after adjustment for diagnostic category and other covariates.

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Section: Discussionmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation Outcomes in Children With Preexisting Neurologic Disorders or Neurofunctional Disability*

Dante

Carroll

et al. 2022

Pediatric Critical Care Medicine

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“…Data are currently insufficient to definitively identify appropriate pediatric ECPR candidates. A recent survey of pediatric critical care physicians demonstrated that ECPR activation decisions are complex and heterogeneous, but most consistently influenced by patient diagnosis (cardiac vs. non-cardiac), CPR duration, arrest location, witnessed arrest, and blood pH ( 183 ). ECPR consideration is currently advised by AHA for patients with cardiac diagnoses when CCPR is failing, but should be reserved to experienced institutions ( 107 ).…”

Section: Pediatric Ecprmentioning

confidence: 99%

Extracorporeal cardiopulmonary resuscitation in adults and children: A review of literature, published guidelines and pediatric single-center program building experience

Olson

Anders²,

Burgman³

et al. 2022

Front. Med.

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Extracorporeal cardiopulmonary resuscitation (ECPR) is an adjunct supportive therapy to conventional cardiopulmonary resuscitation (CCPR) employing veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in the setting of refractory cardiac arrest. Its use has seen a significant increase in the past decade, providing hope for good functional recovery to patients with cardiac arrest refractory to conventional resuscitation maneuvers. This review paper aims to summarize key findings from the ECPR literature available to date as well as the recommendations for ECPR set forth by leading national and international resuscitation societies. Additionally, we describe the successful pediatric ECPR program at Texas Children's Hospital, highlighting the logistical, technical and educational features of the program.

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“…Guidelines specifically acknowledge these lack of data and are unable to provide recommendations in the noncardiac population (10, 13–15). Thus, ECPR deployment in noncardiac patients is determined based on hospital-specific practice guidelines (16, 17).…”

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confidence: 99%

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

Loaec,

Himebauch,

Reeder

et al. 2023

Critical Care Medicine

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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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Factors Associated With Initiation of Extracorporeal Cardiopulmonary Resuscitation in the Pediatric Population: An International Survey

Abstract: Supplemental Digital Content is available in the text.

Cited by 11 publications

References 23 publications

Extracorporeal Membrane Oxygenation Outcomes in Children With Preexisting Neurologic Disorders or Neurofunctional Disability*

Extracorporeal Membrane Oxygenation Outcomes in Children With Preexisting Neurologic Disorders or Neurofunctional Disability*

Extracorporeal cardiopulmonary resuscitation in adults and children: A review of literature, published guidelines and pediatric single-center program building experience

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

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