Pediatric Extracorporeal Cardiopulmonary Resuscitation (ECPR): Understanding Variations in Systems and Clinical Practice

Extracorporeal cardiopulmonary resuscitation (ECPR) for pediatric cardiac arrest relies on enhanced resources and time-critical decision-making. We aimed to evaluate variations in systems and clinical practice among extracorporeal membrane oxygenation (ECMO) centers that offer ECPR for neonatal and pediatric patients using an online survey. Fifty-three ECMO centers participated, representing all five ELSO chapters. All centers had a similar understanding of the ECPR definition. The predominant intensive care unit (ICU) patient population was: cardiac (34%), mixed (51%), general (7.5%), neonatal (1%), and mixed adult and pediatric (6.5%). All centers activated ECPR teams within 10 minutes of starting conventional CPR. Thirty-four (64%) centers keep a primed circuit available for ECPR 24/7. Thirty-six (68%) centers have an institutional protocol on ECPR. The cardiac surgeon was the most common (94%) cannulator. Staffing levels varied during working hours compared to nights and weekends. Thirty-eight (71%) centers did not apply cooling measures during and after the initiation of ECPR. Oxygenation and CO2 strategy varied between centers upon ECMO flow commencement. Forty-two (81%) centers aimed to maintain normothermia and avoid hyperthermia. Twenty-three (44%) centers have guidelines on organ donation and neurodevelopmental follow-up. Conclusion-significant variations exist in systems and clinical practice among ECMO centers offering pediatric ECPR. Further research is needed to understand the reasons for these differences and their impacts on patient outcomes.