Outcomes after extracorporeal cardiopulmonary resuscitation in pediatric in-hospital cardiac arrest: does quality of CPR matter?

Abstract

Background

ECPR patients who receive guideline-compliant CPR will have improved survival to hospital discharge (SHD) compared to patients who do not receive guideline-compliant CPR, regardless of CPR duration.

Methods

Retrospective, observational study from PediRES-Q of IHCA in children (<18 years) requiring ECMO to achieve ROSC. We assessed compliance of 60-sec chest compression (CC) epochs according to 2020 AHA guideline targets. Guideline-compliant CPR defined as > 60% epochs meeting compliance criteria for each target. Differences assessed utilizing Fisher’s exact tests. Logistic regression used to assess guideline compliance and SHD, controlling for age, arterial line, duration of CPR, and clustering by site.

Results

We analyzed 157 index ECPR events (> 5 epochs): 62 infants (<1 year), 52 children (1-<8 years), and 43 adolescents (8-≤18 years) with CPR quality metric data from 20 sites. Median CPR duration 54 mins (IQR 40,66), median weight 12.0 kgs (IQR 6.0,28.5), and 74/157 (47%) with a cardiac diagnosis. Guideline compliance was not significantly associated with SHD after adjusted logistic regression; however, overall compliance was poor across age groups: 0% in < 1 year, 4% in 1-<8 years and 10% in 8–18 years. Age and duration of CPR were significantly associated with SHD, as 8-<18 years had 64% lower odds of SHD than < 8 year (aOR = 0.36 {0.17, 0.76; P = 0.007) and every minute increase in duration of CPR decreased survival odds by 2% (aOR = 0.98 {0.96,1.0; P = 0.02).

Conclusion

While adherence to AHA guideline-complaint CPR was not significantly associated with SHD, patient age and CPR duration were significant predictors. These findings emphasize the need to better understand factors associated with survival after pediatric ECPR while also helping to drive improvements in ECPR care models.