Aim

We aimed to characterize extracorporeal CPR (ECPR) outcomes in our center and to model prediction of severe functional impairment or death at discharge.

Methods

All ECPR events between 2011 and 2019 were reviewed. The primary outcome measure was severe functional impairment or death at discharge (Functional Status Score [FSS] ≥ 16). Organ dysfunction was graded using the Pediatric Logistic Organ Dysfunction Score-2, neuroimaging using the modified Alberta Stroke Program Early Computed Tomography Score. Multivariable logistic regression was used to model FSS ≥ 16 at discharge.

Results

Of the 214 patients who underwent ECPR, 182 (median age 148 days, IQR 14–827) had an in-hospital cardiac arrest and congenital heart disease and were included in the analysis. Of the 110 patients who underwent neuroimaging, 52 (47%) had hypoxic-ischemic injury and 45 (41%) had hemorrhage. In-hospital mortality was 52% at discharge. Of these, 87% died from the withdrawal of life-sustaining therapies; severe neurologic injury was a contributing factor in the decision to withdraw life-sustaining therapies in 50%. The median FSS among survivors was 8 (IQR 6–8), and only one survivor had severe functional impairment. At 6 months, mortality was 57%, and the median FSS among survivors was 6 (IQR 6–8, n = 79). Predictive models identified FSS at admission, single ventricle physiology, extracorporeal membrane oxygenation (ECMO) duration, mean PELOD-2, and worst mASPECTS (or DWI-ASPECTS) as independent predictors of FSS ≥ 16 (AUC = 0.931) and at 6 months (AUC = 0.924).

Conclusion

Mortality and functional impairment following ECPR in children remain high. It is possible to model severe functional impairment or death at discharge with high accuracy using daily post-ECPR data up to 28 days. This represents a prognostically valuable tool and may identify endpoints for future interventional trials.

中文翻译：

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对儿科心脏病患者进行 ECPR 后的严重功能障碍或死亡建模：规划介入试验

目的

我们旨在表征我们中心的体外心肺复苏 (ECPR) 结果，并对严重功能障碍或出院时死亡的预测进行建模。

方法

审查了 2011 年至 2019 年间的所有 ECPR 事件。主要结局指标是出院时严重的功能障碍或死亡（功能状态评分 [FSS] ≥ 16）。使用儿科后勤器官功能障碍评分 2 对器官功能障碍进行分级，使用改良的艾伯塔中风计划早期计算机断层扫描评分进行神经影像学评分。多变量逻辑回归用于模拟出院时 FSS ≥ 16。

结果

在接受 ECPR 的 214 名患者中，182 名（中位年龄 148 天，IQR 14-827）患有院内心脏骤停和先天性心脏病，并被纳入分析。在接受神经影像学检查的 110 名患者中，52 名 (47%) 有缺氧缺血性损伤，45 名 (41%) 有出血。出院时院内死亡率为 52%。其中，87% 死于维持生命治疗的停药；50% 的严重神经损伤是决定停止生命维持治疗的一个促成因素。幸存者的中位 FSS 为 8（IQR 6-8），只有一名幸存者有严重的功能障碍。6 个月时，死亡率为 57%，幸存者的中位 FSS 为 6（IQR 6-8，n = 79）。预测模型将入院时的 FSS、单心室生理、体外膜肺氧合 (ECMO) 持续时间、平均 PELOD-2 和最差 mASPECTS（或 DWI-ASPECTS）确定为 FSS ≥ 16（AUC = 0.931）和 6 个月时的独立预测因子（ AUC = 0.924)。

结论

儿童 ECPR 后的死亡率和功能障碍仍然很高。可以使用长达 28 天的每日 ECPR 后数据对出院时的严重功能障碍或死亡进行高精度建模。这代表了一种具有预后价值的工具，可以确定未来介入试验的终点。