Extracorporeal life support after successful resuscitation from pediatric in-hospital cardiac arrest

Introduction: Over 15,000 children experience in-hospital cardiac arrest (IHCA) each year in the United States. Following the return of spontaneous circulation (ROSC) for most children, the focus turns to providing high quality post-resuscitation care. Extracorporeal life support (ECLS) can be used in the post-arrest period to restore adequate hemodynamics, however the use of post-arrest ECLS is not well described. This study aimed to describe patients who receive post-arrest ECLS to support the development of evidence-based guidelines for this therapy. Methods: Multi-center retrospective study of pediatric patients in the prospectively collected Pediatric Resuscitation Quality (pediRES-Q) Collaborative database, a multicenter international collaborative of children’s hospitals. All patients ≤ 18 years of age in the pediRES-Q database who received ECLS after an initial IHCA between July 1, 2015 and June 2, 2021 were included. Patients were excluded if they received extracorporeal cardiopulmonary resuscitation, defined as cannulation and initiation of ECLS during the IHCA and return of circulation with ELCS. Primary outcome was survival to intensive care unit (ICU) discharge. Results: A total of 56 patients were included, median age was 0.8 years (IQR 0.1-5 years). The most common illness category was medical cardiac (18 patients, 32%) followed by surgical cardiac (14 patients, 25%). Among the cohort, 31 (55%) patients were cannulated via the neck vessels, 10 (18%) through an open chest, and 6 (11%) via femoral vessels. The Pediatric ICU was the most common location, (28 patients, 50%) and the majority of patients were on a vasoactive agent at the time of their arrest (33 patients, 59%). The most common initial rhythm when CPR began was pulseless electrical activity (20 patients, 36%) patients followed by bradycardia (17 patients, 30%) and median duration of CPR was 38 minutes (IQR 19-56 minutes). 30 patients (54%) survived to ICU discharge, 25 (83%) of whom had a good neurologic outcome (PCPC ≤ 2 or unchanged from baseline). Conclusions: More than half of patients who required ECLS in the post-arrest period survived to discharge, with over 80% with good neurologic outcome. Further investigation is needed to support the development of guidelines for initiation of ECLS in the post-arrest period.