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Functional Status Change Among Children With Extracorporeal Membrane Oxygenation to Support Cardiopulmonary Resuscitation in a Pediatric Cardiac ICU

A Single Institution Report*

Beshish, Asaad G., MD1; Baginski, Mathew R., BS2; Johnson, Thomas J., BS2; Deatrick, Barry K., MD3; Barbaro, Ryan P., MD, MS1; Owens, Gabe E., MD, PhD4

Pediatric Critical Care Medicine: July 2018 - Volume 19 - Issue 7 - p 665–671
doi: 10.1097/PCC.0000000000001555
Extracorporeal Support

Objectives: The purpose of this study is to describe the functional status of survivors from extracorporeal cardiopulmonary resuscitation instituted during in-hospital cardiac arrest using the Functional Status Scale. We aimed to determine risk factors leading to the development of new morbidity and unfavorable functional outcomes.

Design: This was a single-center retrospective chart review abstracting patient characteristics/demographic data, duration of cardiopulmonary resuscitation, duration of extracorporeal membrane oxygenation support, as well as maximum lactate levels within 2 hours before and after extracorporeal cardiopulmonary resuscitation. Cardiac arrest was defined as the administration of chest compressions for a nonperfusing cardiac rhythm. Extracorporeal cardiopulmonary resuscitation was defined by instituting extracorporeal membrane oxygenation during active chest compressions. Functional Status Scale scores were calculated at admission and on hospital discharge for patients who survived.

Setting: Patients admitted in the pediatric cardiac ICU at C.S. Mott Children’s Hospital from January 1, 2005, to December 31, 2015.

Patients: Children less than 18 years who underwent extracorporeal cardiopulmonary resuscitation.

Interventions: Not applicable.

Measurements and Main Results: Of 608 extracorporeal membrane oxygenation events during the study period, 80 were extracorporeal cardiopulmonary resuscitation (14%). There were 40 female patients (50%). Median age was 40 days (interquartile range, 9–342 d). Survival to hospital discharge was 48% (38/80). Median Functional Status Scale score at admission was 6 (interquartile range, 6–6) and at hospital discharge 9 (interquartile range, 8–11). Out of 38 survivors, 19 (50%) had a change of Functional Status Scale score greater than or equal to 3, that is consistent with new morbidity, and 26 (68%) had favorable functional outcomes with a change in Functional Status Scale score of less than 5.

Conclusions: This is the first extracorporeal cardiopulmonary resuscitation report to examine changes in Functional Status Scale from admission (baseline) to discharge as a measure of overall functional outcome. Half of surviving patients (19/38) had new morbidity, while 68% (26/38) had favorable outcomes. Lactate levels, duration of cardiopulmonary resuscitation, and duration of extracorporeal membrane oxygenation were not found to be risk factors for the development of new morbidity and poor functional outcomes. Functional Status Scale may be used as a metric to monitor improvement of extracorporeal cardiopulmonary resuscitation outcomes and help guide research initiatives to decrease morbidity in this patient population.

1Division of Pediatric Critical Care, Department of Pediatrics, University of Michigan, Ann Arbor, MI.

2Department of ECMO, University of Michigan, Ann Arbor, MI.

3Division of Cardiac Surgery, University of Maryland, Baltimore, MD.

4Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan, Ann Arbor, MI.

*See also p. 683.

Dr. Barbaro disclosed that he is the International Registry Chair for the Extracorporeal Life Support Organization. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies