Survival in Extracorporeal Cardiopulmonary Resuscitation for Pediatric In-Hospital Cardiac Arrest: Nationwide Cohort Study in Japan, 2011–2022

OBJECTIVES: To describe the rate, characteristics, and outcomes of pediatric extracorporeal cardiopulmonary resuscitation (ECPR) for in-hospital cardiac arrest (IHCA) in Japan and evaluate temporal trends. DESIGN: Retrospective cohort using the Japanese Diagnosis Procedure Combination database from April 2011 to March 2022. SETTING: Nationwide dataset with approximately 50% of all acute care hospitalizations in Japan. PATIENTS: Children of less than 18 years who received ECPR for IHCA. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary outcomes were temporal trends in ECPR utilization and survival to hospital discharge. Among the 8209 pediatric patients with IHCA, 312 received ECPR: the median (interquartile range [IQR]) age was 2 years (IQR, 0-13 yr); and 52% were male. Annual need for ECPR was 3.6 (IQR, 2.9-4.8) cases per 100 IHCA events, with a significant upward trend 2011-2022 (p = 0.0001). Annual need for ECPR was 0.038 (IQR, 0.031-0.046) per 1000 pediatric hospital admissions, and we failed to identify an associated upward trend over time (p = 0.056). Survival to hospital discharge increased from 17.6% in 2011 to 37.5% in 2022, with a significant upward trend over time in the unadjusted analysis (p = 0.036); however, the adjusted temporal analysis failed to show an associated upward trend over time. Survival varied by age and illness category. Secondary analyses showed that cardiac diagnoses, as opposed to noncardiac diagnoses, were associated with higher overall survival: 105 of 213 (49.3%) vs. 24 of 89 (27%); percentage difference, 22.3% (95% CI, 11.3-33.4%); p = 0.0002. CONCLUSIONS: In our national dataset from Japan 2011-2022, we have found that pediatric ECPR for IHCA was used infrequently. Survival to hospital discharge showed a temporal increase over time. These trends may reflect changes in patient volume, guideline implementation, or more refined patient selection for ECPR, as well as resuscitation processes and better systems of clinical practice.