Predicting Survivability of Noncardiac Pediatric Patients Requiring Extracorporeal Cardiopulmonary Resuscitation

Introduction

Application of extracorporeal life support during cardiac arrest is termed extracorporeal cardiopulmonary resuscitation (eCPR). Mortality in pediatric patients undergoing eCPR for noncardiac conditions remains high and factors influencing survival are not well-defined. We hypothesized that eCPR survivors are more likely to have less severe electrolyte derangements prior to cannulation than nonsurvivors.

Methods

A retrospective review of extracorporeal membrane oxygenation (ECMO) data at our free-standing children's hospital from January 2013 through December 2023 was performed. Variables evaluated included demographics, diagnosis, blood gas values, CPR time, and survival. Kruskal–Wallis test was used to compare precannulation labs and CPR duration in those who survived to the nonsurvivors.

Results

We identified 21 patients who underwent CPR during ECMO cannulation over a 10-year period. The most common diagnosis was respiratory failure (n = 8, 38%). The median duration of CPR prior to successful ECMO initiation was 60 min (interquartile range 15-80). Veno-arterial ECMO (n = 20, 95%) was the most common method of cannulation. The median ECMO run time was 84 h (interquartile range 27-183). A single patient died during ECMO cannulation (n = 1, 4.7%). Eight patients survived to discharge (38%). Higher pH, partial pressure of arterial oxygen, and bicarbonate levels prior to cannulation were associated with survival (P < 0.05).

Conclusions

In this study, precannulation pH, partial pressure of arterial oxygen, and bicarbonate median values were significantly higher in those who survived compared to the nonsurvivors. Precannulation characteristics that may influence survivability can potentially assist with decision making regarding inclusion and exclusion criteria for eCPR candidates.