Neurocognitive outcomes in survivors of pediatric E-CPR: Has the Golden age arrived?

摘要

The use of extracorporeal cardiopulmonary resuscitation (E-CPR) is increasing. Nevertheless, because ofthelowquality of evidence with high risk of bias, E-CPR is of uncertain efficacy. In children, recent data from the Get With The Guidelines-Resuscitation registry found that E-CPR for in-hospital cardiac arrest (IH-CA) of duration >10min was associated with improved adjusted and propensity score matched outcomes of survival to hospital discharge, and survival to hospital discharge with favorable neurological outcome. After >35min of chest compressions, E-CPR survival to discharge was 33%, with good neurological outcome in 63% of these survivors. This survival and neurological outcome advantage was not confirmed in the Therapeutic Hypothermia after Pediatric Cardiac Arrest In-Hospital (THAPCA-IH) trial, where extracorporeal membrane oxygenation (ECMO) prior to temperature intervention was not associated with 12-month survival, and associated with worse adjusted 12-month survival with parent-reported Vineland Adaptive Behavior Scales (VABS) >70. This may be due to the differing inclusion criteria, in THAPCA-IH being duration of IH-CA >2min.