Abstract 1770: Outcomes following ECMO use to aid Cardiopulmonary Resuscitation in Children
Introduction: ECMO started during ongoing CPR (E-CPR) has been used to supplement cardiopulmonary resuscitation (CPR) in children. We describe outcomes, and factors associated with survival after E-CPR, using data reported to the Extracorporeal Life Support Organization Registry (ELSO).
Methods: Patients receiving E-CPR during 1992 – 2005 were extracted from the ELSO registry database. Medical conditions leading to cardiac arrest were grouped by ICD-9 diagnosis codes into E-CPR indication groups: ‘cardiac’, ‘neonatal respiratory’, ‘pediatric respiratory’, ‘sepsis’, ‘trauma’ and ‘other disease’. Demographic, pre-ECMO and ECMO support data between patients surviving to hospital discharge and those who died were analyzed. Stepwise forward logistic regression models were used to evaluate factors associated with survival.
Results: Six hundred and ninety E-CPR runs were reported in 682 patients during the study period. Overall survival was 38%. Median age was 3 months (range 0 – 215) and cardiac disease (74%) was the most frequent indication for E-CPR. E-CPR for cardiac disease (42%) or neonatal respiratory disease (50%) had the highest survival compared to pediatric respiratory (20%), sepsis (24%), trauma (18%) and other indications (29%; p = 0.002). Pre E-CPR factors associated with hospital survival included E-CPR indication with cardiac disease (OR 2.1, 95% CI 1.3–3.4) and neonatal respiratory failure (OR 3.2, 95% CI 1.3–7.8) having better survival compared to all other indications, white race (OR 1.5, 95% CI 1.1–2.2) compared to non-whites, pH > 7.17 (OR 2.1, 95% CI 1.2–3.5) and cannulation of the right carotid artery (OR 1.6, 95% CI 1.1–2.3) compared to other arterial sites. Factors during ECMO that were associated with mortality in a multivariable model included: gastrointestinal and pulmonary hemorrhage, creatinine > 1.5 mg/dL, CPR during ECMO, pH < 7.2 despite ECMO support and radiological evidence of central nervous system injury.
Conclusions: Survival for children using E-CPR is 38%. E-CPR use in children with cardiac or neonatal respiratory disease is associated with better survival than other indications. Quality of resuscitation prior to ECMO, and complications during ECMO influence survival in children using ECMO to supplement CPR.