A single center experience and outcomes with central and peripheral cannulations for paediatric extracorporeal cardiopulmonary resuscitation
Bibliographic record
Abstract
BACKGROUND: Cannulation metrics for paediatric extracorporeal cardiopulmonary resuscitation (ECPR) have not been widely reported. We hypothesized that duration of resuscitation and cannulation would be associated with survival, and that difficulty and failure rates may differ between peripheral and central approaches. METHODS: This single-center retrospective study included patients < 18 years with in-hospital ECPR events from 2015 to 2020. The primary and secondary outcomes were survival and favourable neurologic outcomes on hospital discharge. We also set out to evaluate durations of resuscitation and cannulation, characteristics of difficult and failed cannulations, and report the context and mode of death. Statistical methods included non-parametric testing and regression methods. Qualitative assessments were used to describe difficult cannulations. RESULTS: Ninety-two ECPR events met eligibility criteria. Median age was 4 months (IQR 1 month, 16 years), and weight was 4.4 kg (range 1.9-133 kg). Central cannulation was performed in 43% (40/92). Difficult cannulation occurred in 17% (9/52) of peripheral and 13% (5/40) of central cannulations. ECMO flows were achieved in 91% (84/92); failure to achieve flows occurred exclusively with peripheral attempts (N = 8/52). The median (IQR) total resuscitation duration, from time of arrest to ECMO flow initiation (CPA-ECMO), was 31 min (21, 38.6) for central and 36.9 min (31.7, 46.0) for peripheral approaches, P = 0.12. Survival to hospital discharge was associated with the total resuscitation duration (CPA-ECMO) after adjusting for cannulation approach, precipitating event, initial shockable rhythm, and location of cannulation (adjusted OR 0.95, 95% CI 0.92-0.99, p = 0.023). Similarly, the odds of having a favourable neurologic outcome at hospital discharge were associated with the total resuscitation duration (CPA-ECMO) after adjusting for cannulation approach, precipitating event, initial shockable rhythm, and location of cannulation (adjusted OR 0.95, 95% CI 0.92-0.99, p = 0.030). Adjusting for age or patient weight did not change either of these estimates. CONCLUSIONS: In paediatric ECPR, total resuscitation duration remains a key metric associated with patient outcomes. In this single-center study, open peripheral cannulation is associated with more difficult and failed attempts compared to central cannulation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".