DOI: 10.1097/pcc.0000000000003423 ISSN: 1529-7535

Early Cardiac Arrest Hemodynamics, End-Tidal Co 2, and Outcome in Pediatric Extracorporeal Cardiopulmonary Resuscitation: Secondary Analysis of the ICU-RESUScitation Project Dataset (2016–2021)

Andrew R. Yates, Maryam Y. Naim, Ron W. Reeder, Tageldin Ahmed, Russell K. Banks, Michael J. Bell, Robert A. Berg, Robert Bishop, Matthew Bochkoris, Candice Burns, Joseph A. Carcillo, Todd C. Carpenter, J. Michael Dean, J. Wesley Diddle, Myke Federman, Richard Fernandez, Ericka L. Fink, Deborah Franzon, Aisha H. Frazier, Stuart H. Friess, Kathryn Graham, Mark Hall, David A. Hehir, Christopher M. Horvat, Leanna L. Huard, Tensing Maa, Arushi Manga, Patrick S. McQuillen, Ryan W. Morgan, Peter M. Mourani, Vinay M. Nadkarni, Daniel Notterman, Murray M. Pollack, Anil Sapru, Carleen Schneiter, Matthew P. Sharron, Neeraj Srivastava, Bradley Tilford, Shirley Viteri, David Wessel, Heather A. Wolfe, Justin Yeh, Athena F. Zuppa, Robert M. Sutton, Kathleen L. Meert
  • Critical Care and Intensive Care Medicine
  • Pediatrics, Perinatology and Child Health
Show PDF Cite

Objectives:

Cannulation for extracorporeal membrane oxygenation during active extracorporeal cardiopulmonary resuscitation (ECPR) is a method to rescue patients refractory to standard resuscitation. We hypothesized that early arrest hemodynamics and end-tidal C

o
2 (ET
co
2) are associated with survival to hospital discharge with favorable neurologic outcome in pediatric ECPR patients.

Design:

Preplanned, secondary analysis of pediatric Utstein, hemodynamic, and ventilatory data in ECPR patients collected during the 2016–2021 Improving Outcomes from Pediatric Cardiac Arrest study; the ICU-RESUScitation Project (ICU-RESUS; NCT02837497).

Setting:

Eighteen ICUs participated in ICU-RESUS.

Patients:

There were 97 ECPR patients with hemodynamic waveforms during cardiopulmonary resuscitation.

Interventions:

None.

Measurements and Main Results:

Overall, 71 of 97 patients (73%) were younger than 1 year old, 82 of 97 (85%) had congenital heart disease, and 62 of 97 (64%) were postoperative cardiac surgical patients. Forty of 97 patients (41%) survived with favorable neurologic outcome. We failed to find differences in diastolic or systolic blood pressure, proportion achieving age-based target diastolic or systolic blood pressure, or chest compression rate during the initial 10 minutes of CPR between patients who survived with favorable neurologic outcome and those who did not. Thirty-five patients had ET

co
2 data; of 17 survivors with favorable neurologic outcome, four of 17 (24%) had an average ET
co
2 less than 10 mm Hg and two (12%) had a maximum ET
co
2 less than 10 mm Hg during the initial 10 minutes of resuscitation.

Conclusions:

We did not identify an association between early hemodynamics achieved by high-quality CPR and survival to hospital discharge with favorable neurologic outcome after pediatric ECPR. Candidates for ECPR with ET

co
2 less than 10 mm Hg may survive with favorable neurologic outcome.

More from our Archive