Prognostic Evaluation of Mortality after Pediatric Resuscitation Assisted by Extracorporeal Life Support.

Details

Serval ID
serval:BIB_6BBDE0E545E5
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Prognostic Evaluation of Mortality after Pediatric Resuscitation Assisted by Extracorporeal Life Support.
Journal
Journal of pediatric intensive care
Author(s)
De Mul A., Nguyen D.A., Doell C., Perez M.H., Cannizzaro V., Karam O.
ISSN
2146-4618 (Print)
ISSN-L
2146-4626
Publication state
Published
Issued date
06/2019
Peer-reviewed
Oui
Volume
8
Number
2
Pages
57-63
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
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
cardiopulmonary resuscitation, children, extracorporeal life support, extracorporeal membrane oxygenation, prognostic factors
Pubmed
Create date
18/12/2018 11:49
Last modification date
20/08/2019 15:25
Usage data