ECMO for out of hospital refractory cardiac arrest in children: a retrospective multicenter analysis of a regional care program.

UNLABELLED: Extracorporeal membrane oxygenation (ECMO) during cardiopulmonary resuscitation (ECPR) is a lifesaving technology that has been widely described for in-hospital cardiac arrest in children with underlying cardiac disease. However, data regarding its use for pediatric out-of-hospital cardiac arrest (OHCA) remain scarce. We conducted a multicenter retrospective analysis of all pediatric refractory OHCA between January 2022 and June 2024. Medical records of children aged 0 days to 15 years who met the definition of refractory cardiac arrest were reviewed. Among 250 calls for cardiac arrest, 184 met the definition of refractory cardiac arrest. Thirty-three patients fulfilled the inclusion criteria for the regional E-CPR program while the remaining did not. Seventeen patients reached the PICU within the required timeframe, and 13 underwent VA ECMO cannulation (four cannulation attempts failed). Median age was 24.3 months (IQR 9.9-93.8). Median low flow at first call was 25 min (18-40), the median cannulation time was 30 min (20-42), and the median delay between the cardiac arrest and ECMO support initiation was 82 min (50-113). Overall survival was 6% (1/17). Four patients progressed to brain death without organ donation. CONCLUSION: We described a large cohort of ECPR for pediatric out of OHCA. Despite a well-established regional organization, outcomes remained poor. Based on these findings, indications for E-CPR within our network have been restricted to selected etiologies. WHAT IS KNOWN: • Out-of hospital cardiac arrest in children is a devastating event associated with poor outcomes. WHAT IS NEW: • Despite a well establishe regional ECPR program, outcomes of Out-of hospital pediatric cardiac arretremained poor.