Abstract 10: Outcome Of Pediatric In-hospital Cardiac Arrest By Extracorporeal Membrane Oxygenation Implementation During Active Cardiopulmonary Resuscitation
Background: To achieve intact neurological survival is a challange for pediatric cardiac arrest. Here we describe the outcome and identify the factors associated with survival among pediatric patients following extracorporeal cardiopulmonary resuscitation (ECPR) for in-hospital pediatric cardiac arrest.
Method: Retrospective study of 27 pediatric in-hospital cardiac arrest who received extracorporeal membrane oxygenation during active cardiopulmonary resuscitation-.The primary outcome was survival to hospital discharge. The secondary outcome was neurological status after ECPR at hospital discharge and late follow-up. Continuous variables were expressed as medians (inter-quartile range)
Results: . We identified 27 ECPR events. The survival rate to hospital discharge was 41% (11/27). The non-survivors had higher serum lactate levels (14 [10.2–19.6] mmol/L vs 8.5 [4.4 –12.6] mmol/L, p < 0.01), longer durations of cardiopulmonary resuscitation (CPR) (60 [37– 81] minutes vs 45 [25–50] minutes, p < 0.05) with longer activating time for ECMO (12.5 [7.5–33.8] minutes vs 5 [0 –10] minutes, p<0.01),and more renal failure after ECPR (68% 11/16 vs 9% 1/11, p < 0.01). By multivariate analysis, the earlier cohort and renal failure after ECPR were independent risk factors for mortality. Among the11 survivors, 10 of them had good neurological outcomes.
Conclusions: ECPR successfully rescued some pediatric patients who failed rescue with conventional in-hospital CPR. Good neurological outcomes were achieved in the majority of the survivors. Early cohort and post-ECPR renal failure were associated with poor outcomes. Early activation of the ECMO team could possibly shorten the CPR duration and improve the ECPR results.