Extracorporeal Cardiopulmonary Resuscitation Deployment for Cardiac Arrest in the Pediatric Emergency Department Setting: 2000-2023 Report for the American Heart Association's Get With the Guidelines-Resuscitation Investigators

OBJECTIVES: Pediatric in-hospital cardiac arrest (IHCA) events leading to extracorporeal cardiopulmonary resuscitation (E-CPR) most often occur in the ICU in cardiac patients. Since there is little information about using E-CPR for pediatric IHCA in the emergency department (ED), we aimed to describe this population.

DESIGN: The American Heart Association's Get With the Guidelines-Resuscitation (GWTG-R) registry of pediatric IHCA, 2000-2023, a retrospective study.

SETTING: EDs in hospitals contributing to the GWTG-R registry.

PATIENTS: Children less than 18 years old experiencing index IHCA events in the ED where E-CPR was deployed to achieve return of circulation (ROC). Only cardiac and noncardiac illness categories were included.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: We identified 51 children with a median (interquartile range [IQR]) age of 2 years (IQR, 0.3-5 yr). Pulseless electrical activity was the initial pulseless rhythm in 24 of 46 patients (52%), and pulseless ventricular tachycardia in four of 46 patients (9%). Median CPR duration was 68 minutes (IQR, 48-92 min), with a median number of epinephrine doses being 12 (IQR, 7-19). Nonsurvival vs. survival was associated with greater use of IV calcium (28/30 vs. 8/12; difference 35% [95% CI, 8.2-58.2%]; p = 0.01). Overall survival was 17 of 51 (33.3% [95% CI, 22.0-47.0%]). Cardiac, as opposed to noncardiac underlying diagnosis, was associated with a higher percentage of successful E-CPR with ROC (26/27 vs. 18/24; difference, 21% [95% CI, 1.8-45%]; p = 0.025).

CONCLUSIONS: In the GWTG-R registry of pediatric IHCA, covering 23 years, E-CPR deployment for IHCA in the ED was reported 51 times. Overall survival to discharge occurred in one-third of cases. We also noted that an underlying cardiac disorder was associated with higher proportions achieving ROC and discharge survival. Further studies are needed to better understand this population and see whether there are missed opportunities in the ED, beyond the median of one case per year, when E-CPR could have been deployed.