Factors Associated with Survival after Extracorporeal Cardiopulmonary Resuscitation in Noncardiac Pediatric Patients

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INTRODUCTION: Although pediatric extracorporeal cardiopulmonary resuscitation (ECPR) is an increasingly common rescue therapy in refractory cardiac arrest, patient selection remains challenging. Most studies have combined noncardiac with congenital cardiac patients. We aimed to identify factors associated with survival after ECPR in noncardiac patients. METHODS: Using the Extracorporeal Life Support Organization database, we performed a retrospective review of noncardiac pediatric patients with documented prearrest rhythm who underwent ECPR. We analyzed patient characteristics, pre-ECPR data, run time, decannulation reason, and survival to discharge. We used univariate methods to compare survivors with nonsurvivors and stepwise logistic regression to identify factors associated with outcomes. RESULTS: The 502 subjects (Table 1) included neonates (15%), infants (35%), children between 1 and 5 years old (21%), and children more than 5 years old (29%). Most were male (52%) and in the ICU at arrest (67%). Sinus bradycardia was the most common prearrest rhythm, followed by pulseless electrical activity (PEA) and ventricular tachycardia. Of those successfully decannulated, 76% survived to discharge. Obese patients and those of non-white race were less likely to survive (odds ratio [OR] 0.33, 95% CI [0.12 to 0.90]; OR 0.62, 95% CI [0.43 to 0.90] respectively). Subjects with ventricular tachycardia were more likely to survive (OR 1.89, 95% CI [1.06 to 3.39]) than other rhythms. Regression models showed that similar factors were associated with successful decannulation. Table 1. - Patient and Extracorporeal Cardiopulmonary Resuscitation Characteristics by Survival to Discharge. Characteristic All (n = 502) Survived (n = 207) Died (n = 295) p Value Non-white 259 (52%) 92 (44%) 167 (57%) 0.009 Obese 24 (5%) 3 (1%) 21 (7%) 0.007 pH < 7 before ECPR 155 (31%) 55 (27%) 100 (34%) 0.1 Vasopressors before ECPR 340 (68%) 141 (68%) 199 (67%) 0.95 Ventricular fibrillation 49 (10%) 20 (10%) 29 (10%) 0.93 PEA 134 (27%) 48 (23%) 86 (29%) 0.17 Sinus bradycardia 187 (37%) 79 (38%) 108 (37%) 0.79 Ventricular tachycardia 59 (12%) 29 (14%) 30 (10%) 0.24 Asystole 55 (11%) 17 (8%) 38 (13%) 0.13 ECPR, extracorporeal cardiopulmonary resuscitation; PEA, pulseless electrical activity. CONCLUSION: Ventricular tachycardia as a prearrest rhythm was associated with survival to discharge after ECPR. Obese and non-white patients were less likely to survive. Future studies should further investigate causes of survival disparities to optimize identification of appropriate ECPR candidates.

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