Abstract 14927: Extracorporeal Cardiopulmonary Resuscitation (E-CPR) Rescue Following Failed Pediatric In-Hospital CPR: A Report From the American Heart Association Get With the Guidelines-Resuscitation Registry (GWTG-R)
Background: Improved survival outcomes are reported with extracorporeal CPR (E-CPR) rescue after failed conventional CPR in case series of selected adults and children. No large, systematic comparison of pediatric E-CPR rescue vs Continued-CPR (C-CPR) has been reported.
Hypothesis: In children reported to the GWTG-R national registry who failed > 10 minutes of conventional CPR, those receiving E-CPR rescue will be more likely to survive to discharge compared to those receiving C-CPR.
Patients and Methods: Consecutive patients <19 years old with CPR events >10 min duration reported to GWTG-R between Jan 2000-Dec 2011 were identified, excluding events in the delivery room and hospitals without E-CPR capability. Patients were stratified into 6 illness categories: surgical cardiac, medical cardiac, general medical, general surgical, trauma and newborn. Primary outcome was survival to discharge, analyzed by multivariate logistic regression for association between E-CPR rescue and survival.
Results: Of 3106 evaluable patients, 437 (14%) received E-CPR and 2669 (86%) received C-CPR. There was no significant difference in age or sex between groups. E-CPR patients had more pre-existing arrhythmias (29% vs 21%, p < 0.001), cyanotic congenital heart disease (CHD) (23.6% vs. 10%, p < 0.001) and hypotension as cause of arrest (71% v 56%, p<0.001). E-CPR rescue patients more often had a first documented arrest rhythm of VF (13% vs 7%, p<0.001) or PEA (43% vs 34%, p<0.001). Survival to hospital discharge was greater for E-CPR rescue (38%, 167/437) vs C-CPR patients (26%, 698/2669, p < 0.001). Odds ratio for survival to hospital discharge was greater for E-CPR rescue vs C-CPR, after adjusting for key a priori covariates: illness category, first documented rhythm, CHD, and hypotension as cause of arrest (adjusted OR 1.95, 95% CI 1.48-2.58).
Conclusion: Children who failed > 10 min of in-hospital CPR and received E-CPR rescue had better survival to hospital discharge than those who received C-CPR.
- © 2013 by American Heart Association, Inc.