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Modeling severe functional impairment or death following ECPR in pediatric cardiac patients: Planning for an interventional trial.
Sperotto, Francesca; Saengsin, Kwannapas; Danehy, Amy; Godsay, Manasee; Geisser, Diana L; Rivkin, Michael; Amigoni, Angela; Thiagarajan, Ravi R; Kheir, John N.
  • Sperotto F; Departments of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Pediatrics, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA; Pediatric Intensive Care Unit, Department of Women's and Children's Health, University of Padova, Via Giustinian
  • Saengsin K; Departments of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Pediatrics, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA.
  • Danehy A; Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Pediatrics, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA.
  • Godsay M; Departments of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
  • Geisser DL; Departments of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Pediatrics, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA.
  • Rivkin M; Neurology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Pediatrics, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA.
  • Amigoni A; Pediatric Intensive Care Unit, Department of Women's and Children's Health, University of Padova, Via Giustiniani 2, Padova 35128, Italy.
  • Thiagarajan RR; Departments of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Pediatrics, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA.
  • Kheir JN; Departments of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Pediatrics, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA. Electronic address: john.kheir@childrens.harvard.edu.
Resuscitation ; 167: 12-21, 2021 10.
Article in English | MEDLINE | ID: covidwho-1479724
ABSTRACT

AIM:

We aimed to characterize extracorporeal CPR (ECPR) outcomes in our center and to model prediction of severe functional impairment or death at discharge.

METHODS:

All ECPR events between 2011 and 2019 were reviewed. The primary outcome measure was severe functional impairment or death at discharge (Functional Status Score [FSS] ≥ 16). Organ dysfunction was graded using the Pediatric Logistic Organ Dysfunction Score-2, neuroimaging using the modified Alberta Stroke Program Early Computed Tomography Score. Multivariable logistic regression was used to model FSS ≥ 16 at discharge.

RESULTS:

Of the 214 patients who underwent ECPR, 182 (median age 148 days, IQR 14-827) had an in-hospital cardiac arrest and congenital heart disease and were included in the analysis. Of the 110 patients who underwent neuroimaging, 52 (47%) had hypoxic-ischemic injury and 45 (41%) had hemorrhage. In-hospital mortality was 52% at discharge. Of these, 87% died from the withdrawal of life-sustaining therapies; severe neurologic injury was a contributing factor in the decision to withdraw life-sustaining therapies in 50%. The median FSS among survivors was 8 (IQR 6-8), and only one survivor had severe functional impairment. At 6 months, mortality was 57%, and the median FSS among survivors was 6 (IQR 6-8, n = 79). Predictive models identified FSS at admission, single ventricle physiology, extracorporeal membrane oxygenation (ECMO) duration, mean PELOD-2, and worst mASPECTS (or DWI-ASPECTS) as independent predictors of FSS ≥ 16 (AUC = 0.931) and at 6 months (AUC = 0.924).

CONCLUSION:

Mortality and functional impairment following ECPR in children remain high. It is possible to model severe functional impairment or death at discharge with high accuracy using daily post-ECPR data up to 28 days. This represents a prognostically valuable tool and may identify endpoints for future interventional trials.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Extracorporeal Membrane Oxygenation / Cardiopulmonary Resuscitation / Heart Arrest / Heart Defects, Congenital Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Child / Humans Language: English Journal: Resuscitation Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Extracorporeal Membrane Oxygenation / Cardiopulmonary Resuscitation / Heart Arrest / Heart Defects, Congenital Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Child / Humans Language: English Journal: Resuscitation Year: 2021 Document Type: Article