Higher Survival With the Use of Extracorporeal Cardiopulmonary Resuscitation Compared With Conventional Cardiopulmonary Resuscitation in Children Following Cardiac Surgery: Results of an Analysis of the Get With The Guidelines-Resuscitation Registry

Author:

Kobayashi Ryan L.1,Gauvreau Kimberlee1,Alexander Peta M. A.1,Teele Sarah A.1,Fynn-Thompson Francis2,Lasa Javier J.3,Bembea Melania4,Thiagarajan Ravi R.1,

Affiliation:

1. Departments of Cardiology & Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, MA.

2. Department of Cardiac Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA.

3. Divisions of Pediatric Cardiology and Critical Care Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX.

4. Department of Anesthesiology/Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.

Abstract

Objectives: Extracorporeal membrane oxygenation to support cardiopulmonary resuscitation (CPR) is increasingly used in children suffering cardiac arrest after cardiac surgery. However, its efficacy in promoting survival has not been evaluated. We compared survival of pediatric cardiac surgery patients suffering in-hospital cardiac arrest who were resuscitated with extracorporeal CPR (E-CPR) to those resuscitated with conventional CPR (C-CPR) using propensity matching. Design: Retrospective study using multicenter data from the American Heart Association Get With The Guidelines-Resuscitation registry (2008–2020). Setting: Multicenter cardiac arrest database containing cardiac arrest and CPR data from U.S. hospitals. Patients: Cardiac surgical patients younger than 18 years old who suffered in-hospital cardiac arrest and received greater than or equal to 10 minutes of CPR. Interventions: None. Measurements and Main Results: Among 1223 patients, 741 (60.6%) received C-CPR and 482 (39.4%) received E-CPR. E-CPR utilization increased over the study period (p < 0.001). Duration of CPR was longer in E-CPR compared with C-CPR recipients (42 vs. 26 min; p < 0.001). In a propensity score matched cohort (382 E-CPR recipients, 382 C-CPR recipients), E-CPR recipients had survival to discharge (odds ratio [OR], 2.22; 95% CI, 1.7–2.9; p < 0.001). E-CPR survival was only higher when CPR duration was greater than 18 minutes. Propensity matched analysis using patients from institutions contributing at least one E-CPR case (n = 35 centers; 353 E-CPR recipients, 353 C-CPR recipients) similarly demonstrated improved survival in E-CPR recipients compared with those who received C-CPR alone (OR, 2.08; 95% CI, 1.6–2.8; p < 0.001). Conclusions: E-CPR compared with C-CPR improved survival in children suffering cardiac arrest after cardiac surgery requiring CPR greater than or equal to 10 minutes.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Critical Care and Intensive Care Medicine

Reference25 articles.

1. Trends in survival after pediatric in-hospital cardiac arrest in the United States.;Holmberg;Circulation,2019

2. Rapid-response extracorporeal membrane oxygenation to support cardiopulmonary resuscitation in children with cardiac disease.;Kane;Circulation,2010

3. Outcome of cardiopulmonary resuscitation in a pediatric cardiac intensive care unit.;Parra;Crit Care Med,2000

4. Cardiac arrest in infants after congenital heart surgery.;Rhodes;Circulation,1999

5. Extracorporeal membrane oxygenation for postcardiotomy mechanical cardiovascular support in children with congenital heart disease.;Salvin;Paediatr Anaesth,2008

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