Merging Two Hospitals: The Effects on Pediatric Extracorporeal Cardiopulmonary Resuscitation Outcomes

Abstract

In this article, a retrospective study was performed to describe the impact of merging two pediatric intensive care units on the overall and neurocognitive outcomes of children who required extracorporeal cardiopulmonary resuscitation (ECPR). Results from three cohorts were compared: 2008 to 2014: premerge, 2014 to 2017: initial time period postmerge, and 2018 to 2019: established merge. Survival to hospital discharge (and with good neurological outcome) was of 68% (61%), 46% (36%), and 79% (71%), respectively, for the three time periods. Merging two hospitals resulted in a nonsignificant trend toward temporary worse outcomes in pediatric patients requiring ECPR.

Keywords

extracorporeal life support - extracorporeal cardiopulmonary resuscitation - hospital mergers

Publication History

Received: 06 May 2020

Accepted: 16 July 2020

Article published online:
31 August 2020

• References

• 1 Girotra S, Spertus JA, Li Y, Berg RA, Nadkarni VM, Chan PS. American Heart Association Get With The Guidelines–Resuscitation Investigators. Survival trends in pediatric in-hospital cardiac arrests: an analysis from Get With The Guidelines–Resuscitation. Circ Cardiovasc Qual Outcomes 2013; 6 (01) 42-49
• 2 Lasa JJ, Rogers RS, Localio R. et al. Extracorporeal cardiopulmonary resuscitation (E-CPR) during pediatric in-hospital cardiopulmonary arrest is associated with improved survival to discharge: a report from the American Heart Association's Get With The Guidelines–Resuscitation (GWTG-R) Registry. Circulation 2016; 133 (02) 165-176
• 3 del Nido PJ, Dalton HJ, Thompson AE, Siewers RD. Extracorporeal membrane oxygenator rescue in children during cardiac arrest after cardiac surgery. Circulation 1992; 86 (05) II300-II304
• 4 Lequier L, de Caen A. Pediatric ECPR: standard of care?. Resuscitation 2012; 83 (06) 665-666
• 5 Alsoufi B, Al-Radi OO, Nazer RI. et al. Survival outcomes after rescue extracorporeal cardiopulmonary resuscitation in pediatric patients with refractory cardiac arrest. J Thorac Cardiovasc Surg 2007; 134 (04) 952-959.e2
• 6 Alten JA, Klugman D, Raymond TT. et al. Epidemiology and outcomes of cardiac arrest in pediatric cardiac ICUs. Pediatr Crit Care Med 2017; 18 (10) 935-943
• 7 Chrysostomou C, Morell VO, Kuch BA, O'Malley E, Munoz R, Wearden PD. Short- and intermediate-term survival after extracorporeal membrane oxygenation in children with cardiac disease. J Thorac Cardiovasc Surg 2013; 146 (02) 317-325
• 8 Fagnoul D, Combes A, De Backer D. Extracorporeal cardiopulmonary resuscitation. Curr Opin Crit Care 2014; 20 (03) 259-265
• 9 Huang SC, Wu ET, Wang CC. et al. Eleven years of experience with extracorporeal cardiopulmonary resuscitation for paediatric patients with in-hospital cardiac arrest. Resuscitation 2012; 83 (06) 710-714
• 10 Kane DA, Thiagarajan RR, Wypij D. et al. Rapid-response extracorporeal membrane oxygenation to support cardiopulmonary resuscitation in children with cardiac disease. Circulation 2010; 122 (11) S241-S248
• 11 Prodhan P, Fiser RT, Dyamenahalli U. et al. Outcomes after extracorporeal cardiopulmonary resuscitation (ECPR) following refractory pediatric cardiac arrest in the intensive care unit. Resuscitation 2009; 80 (10) 1124-1129
• 12 Raymond TT, Cunnyngham CB, Thompson MT, Thomas JA, Dalton HJ, Nadkarni VM. American Heart Association National Registry of CPR Investigators. Outcomes among neonates, infants, and children after extracorporeal cardiopulmonary resuscitation for refractory inhospital pediatric cardiac arrest: a report from the National Registry of Cardiopulmonary Resuscitation. Pediatr Crit Care Med 2010; 11 (03) 362-371
• 13 Patricio D, Peluso L, Brasseur A. et al. Comparison of extracorporeal and conventional cardiopulmonary resuscitation: a retrospective propensity score matched study. Crit Care 2019; 23 (01) 27
• 14 de Caen AR, Berg MD, Chameides L. et al. Part 12: pediatric advanced life support: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2015; 132 (18, Suppl 2): S526-S542
• 15 Duff JP, Topjian AA, Berg MD. et al. 2019 American Heart Association focused update on pediatric advanced life support: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2019; 140 (24) e904-e914
• 16 Karamlou T, Vafaeezadeh M, Parrish AM. et al. Increased extracorporeal membrane oxygenation center case volume is associated with improved extracorporeal membrane oxygenation survival among pediatric patients. J Thorac Cardiovasc Surg 2013; 145 (02) 470-475
• 17 Yeo HJ, Cho WH, Kim D. Learning curve for multidisciplinary team setup in veno-venous extracorporeal membrane oxygenation for acute respiratory failure. Perfusion 2019; 34 (01) 30-38
• 18 Kelly RB, Harrison RE. Outcome predictors of pediatric extracorporeal cardiopulmonary resuscitation. Pediatr Cardiol 2010; 31 (05) 626-633
• 19 Wolf MJ, Kanter KR, Kirshbom PM, Kogon BE, Wagoner SF. Extracorporeal cardiopulmonary resuscitation for pediatric cardiac patients. Ann Thorac Surg 2012; 94 (03) 874-879 , discussion 879–880
• 20 Morris MC, Wernovsky G, Nadkarni VM. Survival outcomes after extracorporeal cardiopulmonary resuscitation instituted during active chest compressions following refractory in-hospital pediatric cardiac arrest. Pediatr Crit Care Med 2004; 5 (05) 440-446
• 21 Joffe AR, Lequier L, Robertson CM. Pediatric outcomes after extracorporeal membrane oxygenation for cardiac disease and for cardiac arrest: a review. ASAIO J 2012; 58 (04) 297-310
• 22 Garcia Guerra G, Zorzela L, Robertson CM. et al; Western Canadian Complex Pediatric Therapies Follow-up Group. Survival and neurocognitive outcomes in pediatric extracorporeal-cardiopulmonary resuscitation. Resuscitation 2015; 96: 208-213
• 23 Ryu JA, Cho YH, Sung K. et al. Predictors of neurological outcomes after successful extracorporeal cardiopulmonary resuscitation. BMC Anesthesiol 2015; 15: 26
• 24 Sivarajan VB, Best D, Brizard CP, Shekerdemian LS, d'Udekem Y, Butt W. Duration of resuscitation prior to rescue extracorporeal membrane oxygenation impacts outcome in children with heart disease. Intensive Care Med 2011; 37 (05) 853-860
• 25 Bembea MM, Ng DK, Rizkalla N. et al; American Heart Association's Get With The Guidelines – Resuscitation Investigators. Outcomes after extracorporeal cardiopulmonary resuscitation of pediatric in-hospital cardiac arrest: a report from the Get With The Guidelines–Resuscitation and the Extracorporeal Life Support Organization registries. Crit Care Med 2019; 47 (04) e278-e285
• 26 Kramer P, Mommsen A, Miera O, Photiadis J, Berger F, Schmitt KRL. Survival and mid-term neurologic outcome after extracorporeal cardiopulmonary resuscitation in children. Pediatr Crit Care Med 2020; 21 (06) e316-e324
• 27 Wolfe H, Zebuhr C, Topjian AA. et al. Interdisciplinary ICU cardiac arrest debriefing improves survival outcomes*. Crit Care Med 2014; 42 (07) 1688-1695
• 28 Meaney PA, Bobrow BJ, Mancini ME. et al; CPR Quality Summit Investigators, the American Heart Association Emergency Cardiovascular Care Committee, and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation. Cardiopulmonary resuscitation quality: [corrected] improving cardiac resuscitation outcomes both inside and outside the hospital: a consensus statement from the American Heart Association. Circulation 2013; 128 (04) 417-435
• 29 Taeb M, Levin AB, Spaeder MC, Schwartz JM. Comparison of pediatric cardiopulmonary resuscitation quality in classic cardiopulmonary resuscitation and extracorporeal cardiopulmonary resuscitation events using video review. Pediatr Crit Care Med 2018; 19 (09) 831-838
• 30 Chan T, Thiagarajan RR, Frank D, Bratton SL. Survival after extracorporeal cardiopulmonary resuscitation in infants and children with heart disease. J Thorac Cardiovasc Surg 2008; 136 (04) 984-992
• 31 Thiagarajan RR, Laussen PC, Rycus PT, Bartlett RH, Bratton SL. Extracorporeal membrane oxygenation to aid cardiopulmonary resuscitation in infants and children. Circulation 2007; 116 (15) 1693-1700
• 32 Meert KL, Guerguerian AM, Barbaro R. et al; Therapeutic Hypothermia After Pediatric Cardiac Arrest (THAPCA) Trial Investigators. Extracorporeal cardiopulmonary resuscitation: one-year survival and neurobehavioral outcome among infants and children with in-hospital cardiac arrest. Crit Care Med 2019; 47 (03) 393-402
• 33 Mattke AC, Venugopal P. Prognostic evaluation of mortality after pediatric resuscitation assisted by extracorporeal life support. J Pediatr Intensive Care 2019; 8 (03) 191-192
• 34 Extracorporeal Life Support Organization Registry Report: International Summary. Published 2019. Accessed August 8, 2020 at: https://www.elso.org/Registry/Statistics/InternationalSummary.aspx
• 35 De Mul A, Nguyen DA, Doell C, Perez MH, Cannizzaro V, Karam O. Prognostic evaluation of mortality after pediatric resuscitation assisted by extracorporeal life support. J Pediatr Intensive Care 2019; 8 (02) 57-63
• 36 Gaynor M, Laudicella M, Propper C. Can governments do it better? Merger mania and hospital outcomes in the English NHS. J Health Econ 2012; 31 (03) 528-543
• 37 Hayford TB. The impact of hospital mergers on treatment intensity and health outcomes. Health Serv Res 2012; 47 (3 Pt 1): 1008-1029
• 38 Fiser DH, Long N, Roberson PK, Hefley G, Zolten K, Brodie-Fowler M. Relationship of pediatric overall performance category and pediatric cerebral performance category scores at pediatric intensive care unit discharge with outcome measures collected at hospital discharge and 1- and 6-month follow-up assessments. Crit Care Med 2000; 28 (07) 2616-2620