Use of extracorporeal cardiopulmonary resuscitation in pediatric cardiac arrest: lifesaving rescue.

Abstract

Purpose of review: Extracorporeal cardiopulmonary resuscitation (ECPR) is an advanced form of resuscitation where an extracorporeal circuit is used to temporarily support circulation in patients with refractory cardiac arrest. It represents a highly complex and resource-intensive therapy, with outcomes shaped by institutional experience, patient selection, arrest-related factors, and post ECPR care. This review aims to show the clinical advantages of such a complex therapy.

Recent findings: More than 15 000 children undergo cardiopulmonary resuscitation annually for in-hospital cardiac arrest in the United States. ECPR utilization has been increasing over the last 20 years. There has been ongoing uncertainty throughout the years about its efficacy in the pediatric population, especially in the noncardiac population. Recent studies have shown an optimization in outcomes, also in the general pediatric population with increased survival rates and positive neurological outcomes.

Summary: ECPR remains a valuable intervention for rescuing children after refractory cardiac arrest. Current resuscitation guidelines endorse ECPR for pediatric cardiac patients. Although outcomes are encouraging, ECPR remains a complex intervention associated with considerable morbidity, mortality, and resource requirements, including significant financial and personnel investment. Future research should focus on identifying patient-specific predictors of benefit, refining selection criteria, and optimizing peri-arrest and post-ECPR management strategies.