Pediatric extracorporeal cardiopulmonary resuscitation: a multicenter retrospective study over a decade

Background: Pediatric extracorporeal cardiopulmonary resuscitation (ECPR) is increasingly utilized for cardiac arrests that do not respond to standard cardiopulmonary resuscitation (CPR), although multicenter data on outcomes remain scarce.This study evaluated trends, outcomes, and factors associated with survival in pediatric ECPR over a 10-year period.Methods: This multicenter retrospective study was conducted across 12 centers from 2012 to 2021.It included pediatric patients (<18 years) who underwent ECPR.Data were analyzed for period 1 (2012-2016) and period 2 (2017-2021), focusing on survival outcomes and factors associated with mortality.Results: Out of 754 extracorporeal membrane oxygenation (ECMO) cases, 206 (27.3%) involved ECPR.The number of annual ECPR cases decreased from 114 in period 1 to 92 in period 2. The survival rates to hospital discharge improved from 28.1% in period 1 to 34.8% in period 2, with notable improvements in post-cardiotomy survival (23.9% to 43.2%, p=0.032).Cardiac indications were the most common (93.2%), with 53.9% categorized as post-cardiotomy ECMO and 39.3% as cardiac-medical ECMO, the latter showing an increase over time.Among non-survivors, 62.7% died from incurable primary diseases, and 17.6% from hypoxic brain injury or cerebral edema.The median CPR duration before ECMO initiation was 60 minutes.Higher survival rates were observed for CPR durations 30 minutes (47.4% vs. 27.4%,p=0.016) and 60 minutes (38.0% vs. 23.4%,p=0.025).Dialysis for acute kidney injury, especially in post-cardiotomy cases, significantly increased the risk of mortality (p<0.001).Conclusion: Over the past decade, pediatric ECPR has demonstrated improved survival trends, particularly in post-cardiotomy cases.However, outcomes remain challenging.Early initiation of ECMO and optimized management are essential for increasing survival rates.