Director of CICU Advanced Practice Providers Baylor College of Medicine, Texas Children's Hospital Houston, Texas, United States
Abstract:
Introduction: Survival after in-hospital cardiac arrest in pediatric cardiac patients has significantly improved with increasing utilization of extracorporeal cardiopulmonary resuscitation (ECPR). However, reports describing factors associated with survival to ICU discharge with favorable neurologic outcomes in this population remained limited. We sought to evaluate the relationship between ECPR duration and neurologic outcomes of survivors, hypothesizing that favorable neurologic outcomes are associated with shorter ECPR durations.
Methods: This is a single-center exploratory retrospective analysis of patients < 18 years old with underlying acquired/congenital cardiac disease who underwent ECPR after in-hospital cardiac arrest. Neurologic functional status was assessed retrospectively utilizing the Functional Status Scale (FSS) at the time of admission and for survivors to ICU discharge. A favorable neurologic outcome was defined as a change in admit to ICU discharge FSS ≤ 3. Patient and event level variables were captured utilizing Utstein-style reporting. Associations between favorable neurologic outcome and CPR duration prior to ECMO flow were evaluated by univariate analysis.
Results: Amongst 55 ECPR events occurring between 1/7/2012 and 1/10/2020, 53% were classified as cardiac surgical, 41% as cardiac medical, with a median age of 14.8 days at arrest. Survival to ICU discharge was 53% (n=29). Survivors to ICU discharge had shorter ECPR duration prior to ECMO flow as compared to non-survivors (34 min. [30-54] vs 58 min. [44-64], p < 0.01). Amongst survivors to ICU discharge, 55% were found to have a favorable neurologic outcome (n=16). CPR duration was not associated with favorable neurologic outcome in ICU survivors (p=0.52), although older age, male gender, and need for defibrillation during CPR were correlated with improved neurologic outcomes on univariate analysis.
Conclusions: Our analysis confirms the potentially deleterious impact of prolonged ECPR duration on survival to ICU discharge while also furthering our understanding of the impact of advanced resuscitation techniques on the neurologic function of pediatric cardiac patients. Although we did not demonstrate any association between ECPR duration and neurologic outcome amongst survivors to ICU discharge, we were able to demonstrate the feasibility of utilizing the FSS tool amongst the pediatric cardiac ECPR population. Further investigations into neurologic outcomes of this high-risk population may benefit from standardized, validated, and granular neurologic testing at ICU discharge.
