Article thumbnail

Outcome Predictors of Pediatric Extracorporeal Cardiopulmonary Resuscitation

By Robert B. Kelly and Rick E. Harrison


Extracorporeal cardiopulmonary resuscitation (ECPR) allows clinicians to potentially rescue pediatric patients unresponsive to traditional cardiopulmonary resuscitation (CPR). Clinical and laboratory variables predictive of survival to hospital discharge are beginning to emerge. In this retrospective, historical cohort case series, clinical, and laboratory data from 31 pediatric patients (<21 years of age) receiving ECPR from March 2000 to April 2006 at our university-affiliated, tertiary-care children’s hospital were statistically analyzed in an attempt to identify variables predictive of survival to hospital discharge. Seven patients survived to hospital discharge (23%), and 24 patients died. Survival was independent of gender, age, and CPR duration. ECPR survival was, however, associated with a lower pre-ECPR phosphorus concentration (P = 0.002) and a lower pre-ECPR creatinine concentration (P = 0.05). A classification tree analysis, using, in part, a pre-ECPR phosphorus concentration threshold and a CPR ABG base excess concentration threshold, yielded a 96% nominal accuracy of predicting survival to hospital discharge or death. A large, multicenter, prospective cohort study aimed at validating these predictive variables is needed to guide appropriate ECPR patient selection. This study reveals the potential survival benefit of ECPR for pediatric patients, regardless of CPR duration prior to ECPR cannulation

Topics: Original Article
Publisher: Springer-Verlag
OAI identifier:
Provided by: PubMed Central

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.

Suggested articles


  1. (2004). A prospective, population-based study of the epidemiology and outcome of out-of-hospital pediatric cardiopulmonary arrest. Pediatrics 114:157–164 Pediatr Cardiol
  2. (2008). An introduction to classification and regression tree (CART) analysis. Available at: download/lewis1.pdf. Accessed
  3. (2003). Analysis and results of prolonged resuscitation in cardiac patients rescued by extracorporeal membrane oxygenation.
  4. (2005). Central nervous system complications during pediatric extracorporeal life support: incidence and risk factors. Crit Care Med
  5. (1984). Classifi-cation and regression trees.
  6. (1984). Effect of acid-base status on plasma phosphorus response to lactate.
  7. (2006). Emergent use of extracorporeal membrane oxygenation during pediatric cardiac catheterization. Pediatr Crit Care Med 7:212–219
  8. (2008). Extracorporeal Life Support Organization. ECLS cardiac addendum form. Available at: WordForms/ELSOCardiacForm.pdf. Accessed
  9. (2008). Extracorporeal Life Support Organization. ECLS registry form. Available at: RegistryForm.pdf. Accessed
  10. (2008). Extracorporeal Life Support Organization. Registry form instruction sheet. Available at: WordForms/FormInstruction.doc. Accessed
  11. (2005). Extracorporeal life support registry report
  12. (2008). Extracorporeal membrane oxygenation rescue for cardiopulmonary resuscitation in pediatric patients. Crit Care Med 36:1607–1613
  13. (2007). Extracorporeal membrane oxygenation to aid cardiopulmonary resuscitation in infants and children.
  14. (2006). for the National Registry of Cardiopulmonary Resuscitation Investigators
  15. (2001). Hematologic and chemical changes observed during and after cardiac arrest in a canine model—a pilot study.
  16. (2005). Khayat A
  17. (2000). Noninvasive assessment of cardiac ischemic injury using 87Rb and 23Na MR imaging, 31P MR, and optical spectroscopy.
  18. (2005). Stiell IG, for the CanAm Pediatric Cardiac Arrest Investigators
  19. (2004). Survival outcomes after extracorporeal cardiopulmonary resuscitation instituted during active chest compressions following refractory inhospital pediatric cardiac arrest. Pediatr Crit Care Med 5:440–446
  20. (2007). Survival outcomes after rescue extracorporeal cardiopulmonary resuscitation in pediatric patients with refractory cardiac arrest.
  21. (1998). Use of rapid-deployment extracorporeal membrane oxygenation for the resuscitation of pediatric patients with heart disease after cardiac arrest.