Characteristics and outcomes of pediatric extracorporeal cardiopulmonary resuscitation (E-CPR): a nationwide retrospective analysis from the French pediatric ECMO Network.

Abstract

Objective: To report the incidence and outcomes of E-CPR for intra or extra-hospital pediatric refractory cardiac arrest (CA) within the French national pediatric ECMO (Extra Corporeal Membrane Oxygenation) network.

Methods: Retrospective study. Children (0-18 years) who underwent E-CPR for intra or extra-hospital cardiac arrest over a 5-year period (2019-2023) in one of the centers belonging to the network were included for analysis.

Results: A total of 164 patients were included for analysis. Centers reported a median of 6 cases (range: 0-21). Most patients received E-CPR for intra-hospital CA (150, 91.5%), with cardiac origin suspected in 134 (84.3%) patients. Preexistent cardiac disease was reported in 94 patients (57.3%). Survival rate at PICU discharge, hospital discharge and after one-year was 29.9%, 29.3% and 27.4% respectively. We identified male gender (aOR 2.74, 95%CI 1.22 to 6.14, p = 0.014) and higher serum lactate 24 h after CA (aOR 1.11 per mol/L, 95%CI 1.03-1.18, p = 0.003) as independent factors associated with poor prognosis whereas femoral cannulation site (aOR 0.18, 95%CI 0.06 to 0.52, p = 0.002) was associated with favorable outcome.

Conclusion: E-CPR is mostly performed in children with heart disease, with limited use in out-of-hospital settings. Efforts should be made to identify patients in need of ECMO before CA, as the outcome after E-CPR remains poor.