Abstract 2083: Rapid Response Extracorporeal Membrane Oxygenation to Support Cardiopulmonary Resuscitation in Children With Cardiac Disease
Introduction: Survival of children with in-hospital cardiac arrest (CA) is poor. Since 1996, the Cardiovascular Program at Children’s Hospital Boston has maintained a rapid response Extracorporeal Membrane Oxygenation (ECMO) system to aid cardiopulmonary resuscitation (ECPR) in patients with CA unresponsive to conventional resuscitation. We evaluated survival and neurological outcomes after ECPR.
Methods: Children with cardiac disease who had ECPR during 1996 to 2008 were identified from our ECMO database. Multivariable logistic regression analysis including demographic, pre-ECMO resuscitation, and ECMO support details was used to evaluate factors associated with survival to hospital discharge. Survivors were retrospectively assigned a Pediatric Overall Performance Category (POPC) and Pediatric Cerebral Performance Category (PCPC) at discharge or early follow-up to assess neurological outcomes.
Results: There were 183 E-CPR runs in 173 patients (41% of all cardiac ECMO runs). Median age (IQR) was 5.7 (0.4 – 44) mo and weight was 6.0 (3.2–14) kg. Survival to hospital discharge was 51%. Survival (54%) in 103 patients who underwent E-CPR after cardiac surgery did not differ from survival (46%) in non-surgical patients (p=0.26). Survival did not vary by cardiac diagnosis including single ventricle lesions (n=71, survival 51%), two ventricle lesions (n=65, survival 48%), primary myocardial disease (n=31, survival 61%), and pulmonary hypertension (n=6, survival 33%; p=0.52). Median [IQR] resuscitation duration did not differ between survivors and non-survivors (32 [25– 40] vs. 36 [21– 45] min; p=0.46). Lower first arterial blood pH on ECMO (OR 11.7, 95% CI 1.9 –74) and higher peak lactate on ECMO (OR 0.92, 95% CI 0.87– 0.97) decreased survival odds. Similarly, ECMO complications including renal injury (OR 0.36, 95% CI 0.16 – 0.77), liver injury (OR 0.23, 95% CI 0.07– 0.81), and neurological injury (OR 0.28, 95% CI 0.14 – 0.56) decreased survival odds. POPC/PCPC scores were assigned to 91% (n=80) of the survivors, and 74% had scores ≤ 2 indicating none to mild neurological injury.
Conclusion: E-CPR promotes survival in children with cardiac disease who suffer a refractory CA, and is associated with favorable early neurological outcomes.