Characteristics of pediatric non-cardiac extracorporeal cardiopulmonary resuscitation (ECPR) programs in north american hospitals: A cross-sectional survey

ABSTRACT

Background: Extracorporeal cardiopulmonary resuscitation (eCPR) has been applied in the pediatric population, yet there are no standardized inclusion/exclusion criteria, modalities of eCPR, or staffing models. Methods: Cross-sectional survey of hospitals with formalized non-cardiac eCPR programs. Variables included hospital and surgical group demographics, patient characteristics, eCPR inclusion/exclusion criteria, cannulation approaches and mortality. Results: Surveys were completed by 35/49 hospitals in the United States (32) and Canada (3) that have formalized non-cardiac eCPR programs (71% response rate). Respondents tended to work in >200 bed free-standing children's hospitals (22/35, 63%). Pediatric general surgeons perform eCPR in 27/35 (77%) with a median group size of 6.5 surgeons (IQR 5,9);8/35 (23%) of respondents take in-house call and 68% have a formal backup system for eCPR. Dedicated simulation programs were reported by 20/35 (57%) of respondents. Annual eCPR activations average approximately 6/year;approximately 41% of patients survived to decannulation, with 36% surviving to discharge. Cannulations occurred in a variety of settings [ED (in 40% of institutions), PICU (97%), NICU (66%), OR (69%);as well as CICU, Cardiac Catheterization Lab, IR], and were mostly done through a cervical approach. eCPR exclusion criteria included pre-hospital arrest (20/35, 57%), prolonged CPR [variably reported as >30 to >60 minutes] (15/35, 43%), lethal chromosomal anomalies (14/35, 40%), terminal underlying disease (14/35, 40%) and COVID+ status (5/35, 14%). Conclusions: eCPR requires substantial resources and is associated with modest survival outcomes. Codification of indications and surgical approaches may help clarify the utility and success of eCPR in select situations.