What role does ECMO/ECPR play in pediatric cardiac arrest?

What role does ECMO/ECPR play in pediatric cardiac arrest?

• A. Consider ECMO/ECPR in refractory arrest where available and if there are reversible causes and a suitable center.
• B. ECMO should be used in all arrests.
• C. ECMO is contraindicated in children.
• D. Only use if no reversible cause.

Answer: (A)

ECMO/ECPR is a rescue strategy in pediatric cardiac arrest. It provides immediate circulatory and oxygenation support during ongoing CPR, buying time to identify and treat a reversible underlying cause. This approach is most appropriate when standard resuscitation isn’t restoring circulation (refractory arrest) and there’s a plausible, treatable cause (such as myocarditis, cardiomyopathy, arrhythmia, massive pulmonary embolism, toxin exposure, or metabolic derangements), and when a center with ECMO capability and an experienced team is available. Because ECMO is resource-intensive and carries risks (bleeding, infection, neurological injury), it should be used only in selected patients with a reasonable chance of meaningful recovery and within centers equipped to perform rapid cannulation and post-cannulation care. It is not employed in all arrests, and it is not restricted to cases with no reversible cause; rather, a reversible etiology and access to a capable center are key determinants.

ECMO/ECPR is a rescue strategy in pediatric cardiac arrest. It provides immediate circulatory and oxygenation support during ongoing CPR, buying time to identify and treat a reversible underlying cause. This approach is most appropriate when standard resuscitation isn’t restoring circulation (refractory arrest) and there’s a plausible, treatable cause (such as myocarditis, cardiomyopathy, arrhythmia, massive pulmonary embolism, toxin exposure, or metabolic derangements), and when a center with ECMO capability and an experienced team is available. Because ECMO is resource-intensive and carries risks (bleeding, infection, neurological injury), it should be used only in selected patients with a reasonable chance of meaningful recovery and within centers equipped to perform rapid cannulation and post-cannulation care. It is not employed in all arrests, and it is not restricted to cases with no reversible cause; rather, a reversible etiology and access to a capable center are key determinants.