Peta Alexander (United States of America)
Boston Children's Hospital, Harvard Medical School CardiologyAuthor Of 1 Presentation
MODELING FUNCTIONAL OUTCOME FOLLOWING EXTRACORPOREAL CARDIOPULMONARY RESUSCITATION IN PEDIATRIC CARDIAC PATIENTS
Abstract
Background and Aims
Extracorporeal-cardiopulmonary-resuscitation (ECPR) improves survival after in-hospital cardiac arrest. However, functional outcome remains poor. We aimed to characterize ECPR outcomes and develop an accurate model to predict functional outcome at discharge and 6 months, using a validated organ-dysfunction score and, for the first time in pediatrics, a detailed granular neuroimaging score.
Methods
All cardiac ECPR events between 2011-2019 were reviewed. The primary outcome measure was the Functional-Status-Score(FSS) at discharge. Organ-dysfunction was graded using the Pediatric-Logistic-Organ-Dysfunction-Score-2(PELOD-2); neuroimaging was graded using the modified-Alberta-Stroke-Program-Early-Computed-Tomography-Score(ASPECTS)/DWI-ASPECTS. Multivariable logistic regression was used to model FSS≥19 (severe functional impairment) at discharge and at 6 months.
Results
Of the 214 patients who underwent cardiac-ECPR, 182 were included (median age 148 days, IQR 14–827). Seventy-one (39%) had single-ventricle physiology. Neuroimaging was performed in 110 patients: 52 (47%) had hypoxic-ischemic injury, 45 (41%) hemorrhage. Median ECMO duration was 4days (IQR 2-8). Nighty-five patients (52%) either died or exhibited severe functional impairment at discharge. The most accurate predictive model (AUC=0.931) identified FSS at admission, single-ventricle physiology, ECMO duration, mean PELOD-2 in the 0-28 days, and worst mASPECTS/DWI-ASPECTS as independent predictors of poor functional outcome at discharge. The same model predicted severe functional impairment at 6months with an AUC=0.924.
Conclusions
Mortality and functional impairment following ECPR in children remain high. It is possible to model the functional outcome at discharge and at 6months with high accuracy using granular data for organ-dysfunction and brain injury in the 28days following the event. This represents a valuable tool to help physicians defining prognosis and to identify modifiable factors.