Dataset Information

Death by Neurologic Criteria in Children Undergoing Extracorporeal Cardiopulmonary Resuscitation: Retrospective Extracorporeal Life Support Organization Registry Study, 2017-2021.

ABSTRACT:

Objectives

To determine factors associated with brain death in children treated with extracorporeal cardiopulmonary resuscitation (E-cardiopulmonary resuscitation).

Design

Retrospective database study.

Settings

Data reported to the Extracorporeal Life Support Organization (ELSO), 2017-2021.

Patients

Children supported with venoarterial extracorporeal membrane oxygenation (ECMO) for E-cardiopulmonary resuscitation.

Intervention

None.

Measurements and main results

Data from the ELSO Registry included patient characteristics, blood gas values, support therapies, and complications. The primary outcome was brain death (i.e., death by neurologic criteria [DNC]). There were 2,209 children (≥ 29 d to < 18 yr of age) included. The reason for ECMO discontinuation was DNC in 138 patients (6%), and other criteria for death occurred in 886 patients (40%). Recovery occurred in 1,109 patients (50%), and the remaining 76 patients (4%) underwent transplantation. Fine and Gray proportional subdistribution hazards' regression analyses were used to examine the association between variables of interest and DNC. Age greater than 1 year (p < 0.001), arterial blood carbon dioxide tension (Paco2) greater than 82 mm Hg (p = 0.022), baseline lactate greater than 15 mmol/L (p = 0.034), and lactate 24 hours after cannulation greater than 3.8 mmol/L (p < 0.001) were independently associated with greater hazard of subsequent DNC. In contrast, the presence of cardiac disease was associated with a lower hazard of subsequent DNC (subdistribution hazard ratio 0.57 [95% CI, 0.39-0.83] p = 0.004).

Conclusions

In children undergoing E-cardiopulmonary resuscitation, older age, pre-event hypercarbia, higher before and during ECMO lactate levels are associated with DNC. Given the association of DNC with hypercarbia following cardiac arrest, the role of Paco2 management in E-cardiopulmonary resuscitation warrants further studies.

SUBMITTER: Joye R

PROVIDER: S-EPMC10903996 | biostudies-literature | 2023 Nov

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Death by Neurologic Criteria in Children Undergoing Extracorporeal Cardiopulmonary Resuscitation: Retrospective Extracorporeal Life Support Organization Registry Study, 2017-2021.

Joye Raphael R Cousin Vladimir L VL Wacker Julie J Hoskote Aparna A Gebistorf Fabienne F Tonna Joseph E JE Rycus Peter T PT Thiagarajan Ravi R RR Polito Angelo A

Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies 20231120 3

<h4>Objectives</h4>To determine factors associated with brain death in children treated with extracorporeal cardiopulmonary resuscitation (E-cardiopulmonary resuscitation).<h4>Design</h4>Retrospective database study.<h4>Settings</h4>Data reported to the Extracorporeal Life Support Organization (ELSO), 2017-2021.<h4>Patients</h4>Children supported with venoarterial extracorporeal membrane oxygenation (ECMO) for E-cardiopulmonary resuscitation.<h4>Intervention</h4>None.<h4>Measurements and main re ...[more]

PMID: 37982691

Similar Datasets

Project description:BackgroundThis systemic review aimed to explore the predictors of discharge and neurologic outcome of adult extracorporeal cardiopulmonary resuscitation (ECPR) to provide references for patient selection.MethodsElectronically searching of the Pubmed, Embase, Cochrane Library, and manual retrieval were done for clinical trials about predictors for adult ECPR which were published between January 2000 and January 2018 and included predictors for discharge and neurologic outcome. The literature was screened according to inclusion and exclusion criteria, the baseline information and interested outcomes were extracted. Two reviewers assessed the methodologic quality of the included studies and the quality of evidence for summary estimates independently. Pooled mean difference (MD) or odds ratio (OR) and 95% confidence interval (CI) were calculated by Review Manager Software 5.3. At last the quality of evidence for summary estimates was appraised according to Grading of Recommendations Assessment, Development, and Evaluation rating system.ResultsIn 16 studies, 1162 patients were enrolled. Out-of-hospital cardiac arrest (CA) (OR 0.58, 95% CI 0.36-0.93, P = .02), in-hospital CA (OR 1.73, 95% CI 1.08-2.77, P = .02), witnessed CA (OR 5.2, 95% CI 1.18-22.88, P = .01), bystander cardiopulmonary resuscitation (CPR) (OR 7.35, 95% CI 2.32-23.25, P < .01), initial shockable rhythm (OR 2.29, 95% CI 1.53-3.42, P < .01), 1st recorded nonshockable rhythm (OR 0.44, 95% CI 0.29-0.66, P < .01), CPR duration (MD -13.84 minutes, 95% CI -21 to -6.69, P < .0001), arrest-to-extracorporeal membrane oxygenation (ECMO) (MD -17.88 minutes, 95% CI -23.59 to -12.17, P < .01), PH (MD 0.14, 95% CI 0.08-0.21, P < .01), lactate (MD -3.66 mmol/L, 95% CI -7.15 to -0.17, P = .04), and percutaneous coronary intervention (PCI) (OR 1.63, 95% CI 1.02-2.58, P = .04)were identified as the survival predictors of ECPR. Shockable rhythm (OR 2.33, 95% CI 1.20-4.52, P = .01) and CPR duration (MD -9.85 minutes, 95% CI -15.71 to -3.99, P = .001) were identified as the neurologic outcome predictors of ECPR.ConclusionCurrent evidence showed that in-hospital CA, witnessed CA, bystander CPR, initial shockable rhythm, shorter CPR duration and arrest-to-ECMO duration, higher baseline PH, lower baseline lactate and PCI were favourable survival predictors of adult ECPR, and shockable rhythm and shorter CPR duration were good neurological outcome predictors of adult ECPR.

Dataset Information

Death by Neurologic Criteria in Children Undergoing Extracorporeal Cardiopulmonary Resuscitation: Retrospective Extracorporeal Life Support Organization Registry Study, 2017-2021.

Objectives

Design

Settings

Patients

Intervention

Measurements and main results

Conclusions

Publications

Death by Neurologic Criteria in Children Undergoing Extracorporeal Cardiopulmonary Resuscitation: Retrospective Extracorporeal Life Support Organization Registry Study, 2017-2021.

Similar Datasets

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