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

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)

Published:2023-12-13 Issue: Volume: Page:
ISSN:1529-7535
Container-title:Pediatric Critical Care Medicine
language:en
Short-container-title:

Author:

Yates Andrew R.¹,Naim Maryam Y.²,Reeder Ron W.³,Ahmed Tageldin⁴,Banks Russell K.³,Bell Michael J.⁵,Berg Robert A.²,Bishop Robert⁶,Bochkoris Matthew⁷,Burns Candice⁸,Carcillo Joseph A.⁷,Carpenter Todd C.⁶,Dean J. Michael³,Diddle J. Wesley⁵,Federman Myke⁹,Fernandez Richard¹,Fink Ericka L.⁷,Franzon Deborah¹⁰,Frazier Aisha H.¹¹¹²,Friess Stuart H.¹³,Graham Kathryn²,Hall Mark¹,Hehir David A.²,Horvat Christopher M.⁷,Huard Leanna L.⁹,Maa Tensing¹,Manga Arushi¹³,McQuillen Patrick S.¹⁰,Morgan Ryan W.²,Mourani Peter M.¹⁴,Nadkarni Vinay M.²,Notterman Daniel¹⁵,Pollack Murray M.⁵,Sapru Anil⁹,Schneiter Carleen⁶,Sharron Matthew P.⁵,Srivastava Neeraj⁹,Tilford Bradley⁴,Viteri Shirley¹⁶,Wessel David⁵,Wolfe Heather A.²,Yeh Justin⁷,Zuppa Athena F.²,Sutton Robert M.²,Meert Kathleen L.⁴

Affiliation:

1. Department of Pediatrics, Nationwide Children’s Hospital, The Ohio State University, Columbus, OH.

2. Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.

3. Department of Pediatrics, University of Utah, Salt Lake City, UT.

4. Department of Pediatrics, Children’s Hospital of Michigan, Central Michigan University, Detroit, MI.

5. Department of Pediatrics, Children’s National Hospital, George Washington University School of Medicine, Washington, DC.

6. Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO.

7. Department of Critical Care Medicine, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA.

8. Department of Pediatrics and Human Development, Michigan State University, Grand Rapids, MI.

9. Department of Pediatrics, Mattel Children’s Hospital, University of California Los Angeles, Los Angeles, CA.

10. Department of Pediatrics, Benioff Children’s Hospital, University of California, San Francisco, San Francisco, CA.

11. Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE.

12. Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.

13. Department of Pediatrics, Washington University School of Medicine, St. Louis, MO.

14. Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children’s research Institute, Little Rock, AR.

15. Department of Molecular Biology, Princeton University, Princeton, NJ.

16. Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children and Thomas Jefferson University, Wilmington, DE.

Abstract

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 Co 2 (ETco 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 ETco 2 data; of 17 survivors with favorable neurologic outcome, four of 17 (24%) had an average ETco 2 less than 10 mm Hg and two (12%) had a maximum ETco 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 ETco 2 less than 10 mm Hg may survive with favorable neurologic outcome.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Critical Care and Intensive Care Medicine,Pediatrics, Perinatology and Child Health

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