Extracorporeal cardiopulmonary resuscitation for pediatric out-of-hospital cardiac arrest: A review of the Extracorporeal Life Support Organization Registry

Taylor L. Olson, Department of Pediatrics, Division of Critical Care Medicine, Children's National Hospital, George Washington University School of Medicine and Health Sciences, 111 Michigan Avenue NW, Washington, DC, USA. Electronic address: tolson@childrensnational.org.
Hannah W. Kilcoyne, Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine and Health Sciences, 111 Michigan Avenue NW, Washington, DC, USA. Electronic address: hkilcoyne@childrensnational.org.
Raysa Morales-Demori, Department of Pediatrics, Section of Critical Care, Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin Street, Houston, TX, USA. Electronic address: raysa.moralesdemori@bcm.edu.
Peter Rycus, Extracorporeal Life Support Organization, 3001 Miller Road, Ann Arbor, MI, USA. Electronic address: prycus@elso.org.
Ryan P. Barbaro, Department of Pediatrics, Division of Critical Care Medicine, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, USA. Electronic address: barbaror@med.umich.edu.
Peta M A Alexander, Department of Pediatrics, Department of Cardiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, USA. Electronic address: peta.alexander@cardio.chboston.org.
Marc M. Anders, Department of Pediatrics, Section of Critical Care, Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin Street, Houston, TX, USA. Electronic address: marc.anders@bcm.edu.

Document Type

Journal Article

Publication Date

8-31-2024

Journal

Resuscitation

DOI

10.1016/j.resuscitation.2024.110380

Keywords

Cardiopulmonary Resuscitation; Child; Extracorporeal Membrane Oxygenation; Out-of-hospital Cardiac Arrest; Survivors

Abstract

AIMS: Current data are insufficient for the leading resuscitation societies to advise on the use of extracorporeal cardiopulmonary resuscitation (ECPR) for pediatric out-of-hospital cardiac arrest (OHCA). The aim of this study was to explore the current utilization of ECPR for pediatric OHCA and characterize the patient demographics, arrest features, and metabolic parameters associated with survival. METHODS: Retrospective review of the Extracorporeal Life Support Organization Registry database from January 2020 to May 2023, including children 28 days to 18 years old who received ECPR for OHCA. The primary outcome was survival to hospital discharge. RESULTS: Eighty patients met inclusion criteria. Median age was 8.8 years [2.0-15.8] and 53.8% of patients were male. OHCA was witnessed for 65.0% of patients and 46.3% received bystander cardiopulmonary resuscitation (CPR). Initial rhythm was shockable in 26.3% of patients and total CPR duration was 78 minutes [52-106]. Signs of life were noted for 31.3% of patients and a cardiac etiology precipitating event was present in 45.0%. Survival to discharge was 29.9%. Initial shockable rhythm was associated with increased odds of survival (unadjusted OR 4.7 [1.5-14.5]; p=0.006), as were signs of life prior to ECMO (unadjusted OR 7.8 [2.6-23.4]; p<0.001). Lactate levels early on-ECMO (unadjusted OR 0.89 [0.79-0.99]; p=0.02) and at 24 hours on-ECMO (unadjusted OR 0.62 [0.42-0.91]; p<0.001) were associated with decreased odds of survival. CONCLUSIONS: These preliminary data suggest that while overall survival is poor, a carefully selected pediatric OHCA patient may benefit from ECPR. Further studies are needed to understand long-term neurologic outcomes.

Department

Pediatrics

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