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Characteristics of pediatric non-cardiac eCPR programs in United States and Canadian hospitals: A cross-sectional survey

      Highlights

      • What is currently known about this topic: Assisted circulation for cardiopulmonary arrest (eCPR) has become increasingly available in select pediatric institutions. Despite increasing application, questions remain about appropriate inclusion and exclusion criteria, best practices surrounding cannulation, neuroprotection and neurologic outcomes, and ethical concerns.
      • What new information is contained in this article: eCPR may be a useful adjunct in pediatric resuscitation but requires further study to standardize approaches and optimize outcomes.

      Abstract

      Objective

      To characterize practices surrounding pediatric eCPR in the U.S. and Canada.

      Methods

      Cross-sectional survey of U.S. and Canadian hospitals with non-cardiac eCPR programs. Variables included hospital and surgical group demographics, eCPR inclusion/exclusion criteria, cannulation approaches, and outcomes (survival to decannulation and survival to discharge).

      Results

      Surveys were completed by 40 hospitals in the United States (37) and Canada (3) among an estimated 49 programs (82% response rate). Respondents tended to work in >200 bed free-standing children's hospitals (27, 68%). Pediatric general surgeons respond to activations in 32 (80%) cases, with a median group size of 7 (IQR 5,9.5); 8 (20%) responding institutions take in-house call and 63% have a formal back-up system for eCPR. Dedicated simulation programs were reported by 22 (55%) respondents. Annual eCPR activations average approximately 6/year; approximately 39% of patients survived to decannulation, with 35% surviving to discharge. Cannulations occurred in a variety of settings and were mostly done through the neck at the purview of cannulating surgeon/proceduralist. Exclusion criteria used by hospitals included pre-hospital arrest (21, 53%), COVID+ (5, 13%), prolonged CPR (18, 45%), lethal chromosomal anomalies (15, 38%) and terminal underlying disease (14, 35%).

      Conclusions

      While there are some similarities regarding inclusion/exclusion criteria, cannulation location and modality and follow-up in pediatric eCPR, these are not standard across multiple institutions. Survival to discharge after eCPR is modest but data on cost and long-term neurologic sequela are lacking. Codification of indications and surgical approaches may help clarify the utility and success of eCPR.

      Level of evidence

      4

      Keywords

      Abbreviations:

      eCPR (extracorporeal cardiopulmonary resuscitation), ECLS (extracorporeal life support)
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