Outcomes After Extracorporeal Cardiopulmonary Resuscitation of Pediatric In-Hospital Cardiac Arrest: A Report From the Get With the Guidelines-Resuscitation and the Extracorporeal Life Support Organization Registries

Objectives: The aim of this study was to determine cardiac arrest– and extracorporeal membrane oxygenation–related risk factors associated with unfavorable outcomes after extracorporeal cardiopulmonary resuscitation. Design: We performed an analysis of merged data from the Extracorporeal Life Support Organization and the American Heart Association Get With the Guidelines—Resuscitation registries. Setting: A total of 32 hospitals reporting to both registries between 2000 and 2014. Patients: Children younger than 18 years old who suffered in-hospital cardiac arrest and underwent extracorporeal cardiopulmonary resuscitation. Interventions: None. Measurements and Main Results: Of the 593 children included in the final cohort, 240 (40.5%) died prior to decannulation from extracorporeal membrane oxygenation and 352 (59.4%) died prior to hospital discharge. A noncardiac diagnosis and preexisting renal insufficiency were associated with increased odds of death (adjusted odds ratio, 1.85 [95% CI, 1.19–2.89] and 4.74 [95% CI, 2.06–10.9], respectively). The median time from onset of the cardiopulmonary resuscitation event to extracorporeal membrane oxygenation initiation was 48 minutes (interquartile range, 28–70 min). Longer time from onset of the cardiopulmonary resuscitation event to extracorporeal membrane oxygenation initiation was associated with higher odds of death prior to hospital discharge (adjusted odds ratio for each 5 additional minutes of cardiopulmonary resuscitation prior to extracorporeal membrane oxygenation initiation, 1.04 [95% CI, 1.01–1.07]). Each individual adverse event documented during the extracorporeal membrane oxygenation course, including neurologic, pulmonary, renal, metabolic, cardiovascular and hemorrhagic, was associated with higher odds of death, with higher odds as the cumulative number of documented adverse events during the extracorporeal membrane oxygenation course increased. Conclusions: Outcomes after extracorporeal cardiopulmonary resuscitation reported by linking two national registries are encouraging. Noncardiac diagnoses, preexisting renal insufficiency, longer time from onset of the cardiopulmonary resuscitation event to extracorporeal membrane oxygenation initiation, and adverse events during the extracorporeal membrane oxygenation course are associated with worse outcomes. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://bit.ly/29S62lw). Supported, in part, by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health under Award Number K23NS076674 (to Dr. Bembea), and the Extracorporeal Life Support Organization (to Dr. Bembea). Dr. Bembea’s institution received funding from the National Institutes of Health (NIH)/National Institute of Neurological Disorders and Stroke and ELSO. Drs. Bembea and Topjian received support for article research from the NIH. Drs. Bembea and Dalton disclosed off-label product use of ECMO for longer than 6 hours. Dr. Dalton received funding from Innovative ECMO Concepts. Drs. Topjian’s and Hunt’s institutions received funding from the NIH. Dr. Topjian received funding from expert testimony. Dr. Thiagarajan’s institution received funding from Bristol Myers Squibband Pfizer. Dr. Hunt received funding from Zoll Medical Corporation (consulting, and patents on educational technologies, for which Zoll Medical Corporation has a nonexclusive license with her, her institution, and her colleagues to use this technology to generate income). The remaining authors have disclosed that they do not have any potential conflicts of interest. American Heart Association’s Get With The Guidelines—Resuscitation Investigators are listed in the Appendix. For information regarding this article, E-mail: mbembea1@jhmi.edu Copyright © by 2019 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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