Conventional Cardiopulmonary Resuscitation Versus Extracorporeal Membrane Oxygenation Assisted CPR in Children: A Retrospective Analysis of Outcomes and Factors Associated with Conversion from the Former to the Latter

Background/Objectives: Conventional cardiopulmonary resuscitation (CCPR) has been the foundational approach to resuscitating children and adults for decades, providing a lifeline through manual chest compressions and ventilatory support. In cases where CCPR is unsuccessful extracorporeal membrane oxygenation assisted CPR (ECPR) may improve outcomes. Predicting in which patients CCPR is unsuccessful and which patients ECPR should be instituted immediately is difficult and data is lacking. In a retrospective analysis we sought to establish which factors are associated with conversion from CCPR to ECPR. Methods: Patients having a CPR-event that occurred in the PICU between January 2016 and December 2022 were included in the study. Pre CPR-event clinical and laboratory data were collected. Conversion from CCPR to ECPR, and patient outcomes were recorded. Results: 201 CPR-events occurred in 164 children. In 45 patients a conversion from CCPR to ECPR occurred. Time to return of spontaneous circulation or time to ECMO flow was (Median; [IQR]) 2; (1,5) and 37 (21,60) min for CCPR and ECPR-events, respectively. The pre CPR-event maximum lactate was 1.8 and 4.5 mmol/L for CCPR and ECPR-events, respectively. PICU mortality was 27.8% in the CCPR and 50% in the ECPR group. Hospital mortality was similar for the CCPR and ECPR group, respectively. Most deaths occurred because of withdrawal of life sustaining treatments. In multivariable analysis cardiac surgical diagnosis, pre CPR-event lactate as well as duration of CPR were associated with conversion of CCPR to ECPR. Conclusions: Our study demonstrates that pre CPR-event lactate concentrations should alert clinicians to a high likelihood of needing ECPR, as should the duration of CPR. Mortality post CCPR is significant, mainly due to overall illness severity, rather than the consequences of the CPR-event.