First documented rhythm and clinical outcome in children who undergo extracorporeal cardiopulmonary resuscitation for in-hospital cardiac arrest: A report from the american heart association get with the guidelines® - resuscitation registry (GWTG-R)

Tanya Perry; Adnan Bakar; Melania M Bembea; Joanna Fishbein; Todd Sweberg; American Heart Association's Get With The Guidelines®-Resuscitation Investigators

doi:10.1016/j.resuscitation.2023.110040

First documented rhythm and clinical outcome in children who undergo extracorporeal cardiopulmonary resuscitation for in-hospital cardiac arrest: A report from the american heart association get with the guidelines® - resuscitation registry (GWTG-R)

Resuscitation. 2023 Dec:193:110040. doi: 10.1016/j.resuscitation.2023.110040. Epub 2023 Nov 8.

Authors

Tanya Perry¹, Adnan Bakar², Melania M Bembea³, Joanna Fishbein⁴, Todd Sweberg⁵; American Heart Association's Get With The Guidelines®-Resuscitation Investigators

Affiliations

¹ Department of Cardiology, Cincinnati Children's Hospital Medical Center, The Heart Institute, The University of Cincinnati College of Medicine, Cincinnati, OH, USA. Electronic address: Tanya.Perry@cchmc.org.
² Division of Pediatric Critical Care, Department of Pediatrics, Bernard & Millie Duker Children's Hospital, Albany, NY, USA.
³ Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁴ Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.
⁵ Department of Pediatric Critical Care Medicine, Cohen Children's Medical Center, Northwell Health, Zucker School of Medicine, Hofstra University, New Hyde Park, NY, USA.

PMID: 37949164
DOI: 10.1016/j.resuscitation.2023.110040

Abstract

Introduction: Outcomes of conventional cardiopulmonary resuscitation are improved when the initial rhythm is shockable (ventricular fibrillation or pulseless ventricular tachycardia). In children, the first documented rhythm is typically asystole or pulseless electrical activity. We evaluate the role the initial rhythm plays in outcomes for children undergoing extracorporeal cardiopulmonary resuscitation (ECPR) for in-hospital cardiac arrest.

Methods: Consecutive patients < 18 years with in-hospital ECPR events ≥ 10 minutes reported to the American Heart Association Get With The Guidelines® - Resuscitation registry from 2014 to 2019 were included. Primary outcome was survival to hospital discharge. Logistic regression modeling was used to compute propensity score matching based on patient, cardiac arrest event and hospital characteristics; patients with initial shockable rhythm were matched to patients with initial non-shockable rhythm.

Results: The final cohort included 466 patients, of which 82 (18%) had a shockable, and 384 (82%) had a non-shockable initial rhythm. After propensity score matching of 287 (62%) patients, there was no difference in survival to hospital discharge (risk ratio [RR] 1.2, 95% CI, 0.95-1.53, p = 0.13) or favorable neurologic outcome, defined as Pediatric Cerebral Performance Category (PCPC) of 1 or 2, or no decline from baseline (RR 1.28, 95% CI, 0.84-1.96, p = 0.25) between patients with and without shockable initial rhythm.

Conclusions: In children with in-hospital cardiac arrest undergoing ECPR, there was no significant difference in survival or favorable neurologic outcome between those with initial shockable rhythm compared to non-shockable rhythm. Further investigation to evaluate ECPR patient characteristics and outcomes is warranted to help guide eligibility and ECMO deployment practices.

Keywords: Cardiac arrest; Extracorporeal cardiopulmonary resuscitation; Extracorporeal membrane oxygenation; Pediatric arrhythmia; Pediatric cardiac arrest; Pediatric critical care.

MeSH terms

American Heart Association
Cardiopulmonary Resuscitation*
Child
Heart Arrest* / therapy
Hospitals
Humans
Registries
Retrospective Studies