Abstract
INTRODUCTION: Survival after cardiopulmonary resuscitation (CPR) in children remains poor. The use of extracorporeal membrane oxygenation (ECMO) during or shortly after CPR (E-CPR) has been advocated as a strategy to improve outcomes. However, previous studies have been limited by lack of a conventional CPR (C-CPR) control group. HYPOTHESIS: E-CPR is associated with improved survival to hospital discharge compared with C-CPR. METHODS: Retrospective review of the 2000, 2003, and 2006 Kids' Inpatient Database, a large nationally representative database of pediatric hospital admissions, was performed. All episodes of CPR were identified; E-CPR was defined as the use of ECMO on the same day as CPR. Propensity scores were constructed reflecting the likelihood of E-CPR with arrest. Univariate, multivariable, and propensity matched analyses were performed to assess the influence of E-CPR on survival. RESULTS: Out of 8.6 million pediatric hospitalizations, 9,000 CPR events were identified, of which 82 were E-CPR (0.9%). Factors associated with E-CPR use included age > 1 year, congenital heart disease, myocarditis, and hospitalization in a children's hospital (p<0.001 for all). E-CPR was associated with higher hospital charges (median $187,661, interquartile range (IQR) $107,865 - $311,196) compared to C-CPR (median $23,157, IQR $5,875 - $92,004) (p<0.001). Overall, hospital mortality was significantly higher with E-CPR (65.9%) compared to C-CPR (50.9%) (OR 1.9, 95% CI 1.2 - 2.9). Other factors associated with increased mortality after CPR included age > 1 year, sepsis, congenital heart disease, and acute renal failure (p<0.001 for all). Multivariable analysis controlling for age, hospital type, and comorbid conditions revealed no survival difference between E-CPR and C-CPR (OR 0.94, 95% CI 0.6-1.5). Propensity matched analysis also demonstrated similar survival between E-CPR and C-CPR (OR 0.68, 95% CI 0.4-1.2). CONCLUSIONS: E-CPR is rarely utilized for pediatric in-hospital cardiac arrest in the US. E-CPR was not associated with improved survival compared to C-CPR. However, E-CPR was associated with an 8 fold increase in hospital charges. Further study is needed to identify patients most likely to benefit from this resource-intensive therapy.
Published Version
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