Giacomo Veronese, Lorenzo Grazioli, Paolo Meani, Oliviero Fochi, Francesco Fazzi, Alfio Bronco, Giovanna Colombo, Maddalena Serafini, Alessandra Salurso, Isabella Pellicioli, Floriana Ferrari, Sergio Vedovati, Oliviero Francesco Valoti, Davide Ghitti, Silvia Viscardi, Enrico Ammirati, Francesco Seddio, Nicola Uricchio, Daniele Bonacina, Camilla Volpi, Francesca Raimondi, Ezio Bonanomi, Roberto Lorusso, Ferdinando Luca Lorini
Pediatric OHCA-ECPR yielded limited but meaningful survival. Measures of early resuscitation quality, low-flow duration, and early metabolic and organ-injury profiles may help distinguish different clinical trajectories after pediatric OHCA-ECPR.
AIMS: To characterize management, outcomes, and donation trajectories of pediatric extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest (OHCA), and to describe early features observed among survivors and non-survivors.
METHODS: We conducted a retrospective single-centre observational cohort study including all consecutive children (<18 years) treated with ECPR for OHCA at a tertiary pediatric ECMO referral centre between 1 January 2013 and 31 December 2025. Survivors were compared with non-survivors, and among non-survivors, patients with brain death diagnosis were compared with those without brain death diagnosis.
RESULTS: Among 155 pediatric OHCA patients managed at our institution during the study period, 42 (27.1%) underwent ECPR and were included in the present analysis. Median age was 9 years, median low-flow time 85 min, and median ECMO duration 55 h. Survival to hospital discharge was 19.0% (8/42). In exploratory comparisons, survivors more often received bystander CPR (100.0% vs 52.9%, p=0.016), had more frequent transient pre-hospital ROSC (62.5% vs 20.6%, p=0.031), and shorter low-flow duration (53 vs 90 min, p=0.006) than non-survivors. Survivors also had lower initial lactate (11.18 vs 18.00 mmol/L, p=0.003), lower 24-h vasoactive-inotropic score (5 vs 18, p=0.0053), and lower 24-h transfusion burden (12 vs 40 mL/kg, p=0.029). Non-survivors had more severe and persistent early organ injury. Of 34 deaths, 12 had a brain death diagnosis (35.3% of non-survivors; 28.6% of the total cohort), and 4 became effective organ donors. At last follow-up (median, 412 days), 7 of 8 hospital survivors were alive, and 6 of 7 had PCPC ≤2.
CONCLUSIONS: Pediatric OHCA-ECPR yielded limited but meaningful survival. Measures of early resuscitation quality, low-flow duration, and early metabolic and organ-injury profiles may help distinguish different clinical trajectories after pediatric OHCA-ECPR.