Project Summary/Abstract
Pediatric cardiac arrest is a serious life-threatening problem affecting more than 15,000 hospitalized children each
year in the US alone. Fewer than 50% of these children survive to hospital discharge, and neurological morbidity
is common among those who survive. Importantly, pediatric cardiac arrest survival outcomes plateaued more
than a decade ago, and there is hence a critical need for evidence-based and innovative therapeutic approaches.
In particular, a significant number of patients fail to achieve return of spontaneous circulation (ROSC) even af-
ter 30 minutes of conventional CPR and may be candidates for what is termed Extracorporeal cardiopulmonary
resuscitation (ECPR). ECPR is a treatment that involves the use of veno-arterial extracorporeal membrane oxy-
genation (VA-ECMO) and has been used successfully for resuscitation from shock or cardiac arrest in adult and
pediatric patients. It is often utilized as an alternative resuscitation intervention for in-hospital Cardiac Arrest
(IHCA) patients. Currently it is not clear if and which subpopulation of cardiac arrest victims may benefit from
this intervention. Hence this proposal aims to develop advanced machine learning and signal processing algo-
rithms using a sizeable, high-quality dataset which will identify specific underlying characteristics of the patient
who would benefit from ECPR. In particular, in Aim 1, we will develop a model using pre-arrest demographic,
physiologic, and biochemical data to predict failure to achieve ROSC within 30 minutes of CPR. We will also de-
velop a model using pre-arrest and intra-arrest physiologic data, including continuous invasive and non-invasive
waveform data over the first <5, <10, <15, <20, <30 minutes of CPR to predict failure to achieve ROSC. In Aim
2, we will identify pre- and intra-arrest characteristics from discontinuous data and continuous invasive and
non-invasive waveform data of ECPR and develop a model to predict survivability to hospital discharge. Such a
model would enable initiation of ECPR in critically ill patients who are unlikely to survive otherwise and hence
lead to overall improvement of survival for in-hospital CPR patients.
