Abstract
To improve survival rates during cardiopulmonary resuscitation (CPR), some patients
are put on extracorporeal life support (ECLS) during active resuscitation (ECPR).
Our objective was to assess the clinical outcomes after pediatric ECPR in Switzerland
and to determine pre-ECPR prognostic factors for mortality. The present study is a
retrospective analysis. The study setting included three pediatric intensive care
units in Switzerland that use ECPR. All patients (<16 years old) undergoing ECPR from
2008 to 2016 were included in the study. There were no interventions. Data before
ECLS initiation and clinical outcomes were collected. An ECPR score was designed to
predict mortality, based on variables significantly different between survivors and
non-survivors. Fifty-five patients were included, with a median age of 13.5 months.
Eighty percent were cardiac patients. The mortality rate was 75%. Mortality was significantly
associated with CPR duration (p = 0.02), last lactate (p = 0.05), and last pH (p = 0.01) before ECLS initiation. Based on these three variables, an ECPR score was
designed as follows: CPR duration (in minutes): 1 point if < 40; 2 points if ≥ 40;
3 points if ≥ 60; 6 points if ≥ 105. Lactate (in mmol/L): 1 point if < 8; 2 points
if ≥ 8; 3 points if ≥ 14; 6 points if ≥ 18. pH: 1 point if > 7.00; 2 points if ≤ 7.00;
3 points if ≤ 6.85; 6 points if ≤ 6.60. The area under the receiver-operating characteristic
curve was 0.74. The positive predictive value of a score ≥ 9 was 94%. In our population,
a score based on three variables easily available prior to ECLS initiation had good
discrimination and could appropriately predict mortality. This score now needs validation
in a larger population.
Keywords
extracorporeal life support - extracorporeal membrane oxygenation - cardiopulmonary
resuscitation - prognostic factors - children
