The approach to extracorporeal cardiopulmonary resuscitation (ECPR) in children. A narrative review by the paediatric ECPR working group of EuroELSO

Extracorporeal Cardiopulmonary Resuscitation (ECPR) has potential benefits compared to conventional Cardiopulmonary Resuscitation (CCPR) in children. Although no randomised trials for paediatric ECPR have been conducted, there is extensive literature on survival, neurological outcome and risk factors for survival. Based on current literature and guidelines, we suggest recommendations for deployment of paediatric ECPR emphasising the requirement for protocols, training, and timely intervention to enhance patient outcomes. Factors related to outcomes of paediatric ECPR include initial underlying rhythm, CCPR duration, quality of CCPR, medications during CCPR, cannulation site, acidosis and renal dysfunction. Based on current evidence and experience, we provide an approach to patient selection, ECMO initiation and management in ECPR regarding blood and sweep flow settings, unloading of the left ventricle, diagnostics whilst on ECMO, temperature targets, neuromonitoring as well as suggested weaning and decannulation strategies.

Update and outcomes in extracorporeal life support

The Extracorporeal Life Support Organization Registry has collected outcome data of almost 56,000 patients receiving extracorporeal life support (ECLS) over the last 24 years. The use of neonatal respiratory ECLS declined from a peak of 1516 cases in 1992 to 750-865 cases from 2008 to 2012. The 26,583 cases of neonatal respiratory ECLS (75% survival) represent the largest patient population in the registry. Indicating the rapid growth in other patient populations, 2013 marks the first year where the number of neonatal respiratory ECLS cases is less than 50% of the registry. Stagnant at ~200 cases/year from 1993 to 2004, growth is occurring in the use of pediatric respiratory ECLS with 331-448 cases/year from 2008 to 2012 (58% survival). Similarly, adult respiratory ECLS use increases have been seen from ~100 cases/year from 1996 to 2007 to 480-846 cases/year from 2009 to 2012 (58% survival). Just over 15,000 cardiac ECLS patients have survival rates of 40%, 49%, and 40% for neonates, pediatric, and adults, respectively.