Extracorporeal Cardiopulmonary Resuscitation In Neonates And Pediatrics In Asia Pacific,Data From Extracorporeal Life Support Organization Registry,1999-2016

[Objective]To investigate trends in survival and demographic details for children with E-CPR in Asia Pacific recorded in Extracorporeal Life Support Organization(ELSO)registry from 1999 to 2016 and identify risk factors associated with in-hospital mortality.[Methods]We retrospectively analyzed data of children younger than 18 years of age who received E-CPR over the past 18 years in Asia Pacific.We extracted data from ELSO registry and divided them into two 9-year groups to assess temporal changes using univariable analysis.Then,we performed univariable and multivariable analyses between survivors and non-survivors to identify factors independently associated with in-hospital mortality.[Results]A total of 321 children were included in our study,and divided patients into two 9-year groups(1999-2007,2008-2016),58 patients in group 1 and 263 patients in group 2.Though survival rates were similar between the groups(43.1%for group 1 vs.52.5%for group 2;p=0.196),age(1.7 months vs 5.6 months,P = 0.03)and weight(3.7 Kg vs.6.0 Kg,P = 0.02)of children increased while proportion of congenital heart disease(44 vs.152,P=0.011)and cardiogenic shock(21 vs.19,P<0.001)decreased.The incidence of E-CPR complications decreased significantly,including mechanical complications:oxygenator dysfunction(9 vs.19,P = 0.043),bridging clots(18 vs.47,P = 0.024);bleeding complications:surgery Hemorrhage(13 vs28,P=0.015),hemolysis(29 vs.38,P<0.001); neurological complications:cerebral infarction(11 vs.17,P=0.002);renal complications:serum creatinine 1.5-3.0 mg/dL(19 vs.36,P<0.001),requiring hemodialysis(9 vs.8,P<0.001),requiring continuous arteriovenous hemofiltration(6 vs.4,P=0.002);cardiovascular complications:Arrhythmia(2 vs.35,P=0.033);other complications:clinically confirmed infection(23 vs.44,P<0.001),blood glucose>240 mg/dL(26 vs.67,P=0.003).Comparison between survivors and non-survivors showed that Asian race was more common in non-survivors and narcotics as well as neuromuscular blockers use were the opposite.Multivariate logistic regression analysis about ECMO complications showe that DIC,myocardial stunning and neurological complications were independently associated with increased odds of hospital mortality.[Conclusion]More children have benefitted from EPCR with broader indications and less complications as time goes on in Asia Pacific.ECMO complications such as myocardial stunning are associated with decreased survival independently.