University of Washington, Department of General Surgery, Seattle, WA, United States of America.
VA Puget Sound Health Care System, Health Services Research and Development, Seattle, WA, United States of America; University of Washington, Department of Health Systems and Population Health, Seattle, WA, United States of America.
Am J Emerg Med. 2024 Jul;81:35-39. doi: 10.1016/j.ajem.2024.03.035. Epub 2024 Apr 7.
Data suggest extracorporeal cardiopulmonary resuscitation (ECPR) improves survival in adult patients with refractory cardiac arrest; however, ECPR outcomes in pediatric patients with out-of-hospital cardiac arrest (OHCA) is lacking. The primary aim of this study was to characterize pediatric patients who experience OHCA or cardiac arrest in the ED (EDCA). The secondary aim was to examine associations of cardiac arrest and location of ECPR cannulation with mortality.
We performed a retrospective analysis of the Extracorporeal Life Support Organization registry. We included pediatric patients (age > 28 days to <18 years) who received ECPR for refractory OHCA or EDCA between 2010 and 2019. Patient, cardiac arrest, and ECPR cannulation characteristics were summarized. We examined associations of location of cardiac arrest and ECPR cannulation with in-hospital mortality using multivariable logistic regression.
We analyzed data from 140 pediatric patients. 66 patients (47%) experienced OHCA and 74 patients (53%) experienced EDCA. Overall survival to hospital discharge was 31% (20% OHCA survival vs. 41% EDCA survival, p = 0.008). In adjusted analyses, OHCA was associated with 3.9 times greater odds of mortality (95% confidence interval [CI] 1.61, 9.81) when compared to compared to EDCA. The location of ECPR cannulation was not associated with mortality (odds ratio 1.8, 95% CI 0.75, 4.3).
The use of ECPR for pediatric patients with refractory OHCA is associated with poor survival compared to patients with EDCA. Location of ECPR cannulation does not appear to be associated with mortality.
有数据表明，体外心肺复苏（ECPR）可提高成人难治性心搏骤停患者的存活率；然而，院外心搏骤停（OHCA）儿科患者的 ECPR 结果尚不清楚。本研究的主要目的是描述经历 OHCA 或 EDCA 的儿科患者。次要目的是检查心搏骤停和 ECPR 插管位置与死亡率之间的关联。
我们对体外生命支持组织登记处进行了回顾性分析。我们纳入了 2010 年至 2019 年期间因难治性 OHCA 或 EDCA 接受 ECPR 的儿科患者（年龄>28 天至<18 岁）。总结了患者、心搏骤停和 ECPR 插管的特征。我们使用多变量逻辑回归分析心搏骤停和 ECPR 插管位置与住院死亡率的关联。
我们分析了 140 名儿科患者的数据。66 名患者（47%）经历了 OHCA，74 名患者（53%）经历了 EDCA。总的院内存活率为 31%（20%的 OHCA 存活率与 41%的 EDCA 存活率相比，p=0.008）。在调整后的分析中，与 EDCA 相比，OHCA 与死亡率增加 3.9 倍相关（95%置信区间 [CI] 1.61，9.81）。ECPR 插管位置与死亡率无关（比值比 1.8，95% CI 0.75，4.3）。
与 EDCA 患者相比，ECPR 用于难治性 OHCA 儿科患者的存活率较差。ECPR 插管位置似乎与死亡率无关。
