Survival and neurocognitive outcomes in pediatric extracorporeal-cardiopulmonary resuscitation

• Published in: Resuscitation Vol. 96; pp. 208 - 213
• Main Authors: Garcia Guerra, Gonzalo, Zorzela, Liliane, Robertson, Charlene M.T, Alton, Gwen Y, Joffe, Ari R, Moez, Elham Khodayari, Dinu, Irina A, Ross, David B, Rebeyka, Ivan M, Lequier, Laurance
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01.11.2015
• Subjects: Alberta - epidemiology; Cardiopulmonary resuscitation; Cardiopulmonary Resuscitation - methods; Child, Preschool; Cognition - physiology; Critical care; Emergency; Extracorporeal life support; Extracorporeal Membrane Oxygenation - methods; Female; Follow-Up Studies; Heart Arrest - complications; Heart Arrest - mortality; Heart Arrest - therapy; Humans; Male; Neurocognitive Disorders - epidemiology; Neurocognitive Disorders - etiology; Neurocognitive outcomes; Prognosis; Prospective Studies; Survival Rate - trends; Time Factors; Alberta; Critical care; Cardiopulmonary resuscitation; Extracorporeal life support; Neurocognitive outcomes
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/j.resuscitation.2015.07.034

Abstract Objective Extracorporeal Cardiopulmonary Resuscitation (E-CPR) is the initiation of extracorporeal life support during active chest compressions. There are no studies describing detailed neurocognitive outcomes of this population. We aim to describe the survival and neurocognitive outcomes of children who received E-CPR. Methods Prospective cohort study. Children who received E-CPR at the Stollery Children's Hospital between 2000 and 2010 were included. Neurocognitive follow-up, including Wechsler Preschool and Primary Scales of Intelligence, was completed at the age of 4.5 years, and at a minimum of 6 months after the E-CPR admission. Results Fifty-five patients received E-CPR between 2000 and 2010. Children with cardiac disease had a 49% survival to hospital discharge and 43% survival at age 5-years, with no survivors ( n = 4) in those with non-cardiac disease. Pediatric E-CPR survivors had a mean (SD) Full Scale Intelligence quotient (FSIQ) score of 76.5 (15.9); with 4 children (24%) having intellectual disability (defined as FSIQ over 2 standard deviations below the population mean; i.e., <70). Multiple Cox regression analysis found that mechanical ventilation prior to E-CPR, open chest CPR, longer duration of CPR, low pH and more red blood cells given on the first day of ECMO, and longer time for lactate to normalize on ECMO were associated with higher mortality at age 5-years. Conclusion Pediatric patients with cardiac disease who required E-CPR had 43% survival at age 5 years. Of concern, the intelligence quotient in E-CPR survivors was significantly lower than the population mean, with 24% having intellectual disability.