Extracorporeal-Cardiopulmonary Resuscitation (E-CPR) During Pediatric In-Hospital Cardiopulmonary Arrest is Associated with Improved Survival to Discharge: A Report from the American Heart Association's Get With the Guidelines® - Resuscitation Registry (GWTG-R)
Background—Although extracorporeal CPR (E-CPR) can result in survival after failed conventional CPR (C-CPR), no large, systematic comparison of pediatric E-CPR versus continued C-CPR has been reported.
Methods and Results—Consecutive patients <18 years old with CPR events ≥ 10 minutes duration reported to GWTG-R between January 2000 and December 2011 were identified. Hospitals were grouped by teaching status and location. Primary outcome was survival to discharge. Regression modeling was performed conditioning on hospital groups. A secondary analysis was performed using propensity-score matching. Of 3,756 evaluable patients, 591 (16%) received E-CPR and 3,165 (84%) received C-CPR only. Survival to hospital discharge and survival with favorable neurologic outcome (Pediatric Cerebral Performance Category score of 1-3 or unchanged from admission) were greater for E-CPR [40% (237/591) and 27% (133/496)] versus C-CPR patients [27% (862/3,165) and 18% (512/2,840)]. Odds ratios for survival to hospital discharge and survival with favorable neurologic outcome were greater for E-CPR versus C-CPR. After adjusting for covariates, patients receiving E-CPR had higher odds of survival to discharge [OR 2.80, 95% CI 2.13-3.69, p <0.001] and survival with favorable neurologic outcome [OR 2.64, 95% CI 1.91-3.64, p < 0.001] than patient who received C-CPR. This association persisted when analyzed by propensity-score matched cohorts [OR 1.70, 95% CI 1.33-2.18, p < 0.001 and OR 1.78, 95% CI 1.31-2.41, p < 0.001 respectively].
Conclusions—For children with in-hospital CPR ≥ 10 minutes duration, E-CPR was associated with improved survival to hospital discharge and survival with favorable neurologic outcome when compared to C-CPR.
- Received April 7, 2015.
- Revision received October 1, 2015.
- Accepted October 9, 2015.