Pediatric IHCA with ECPR: ECMO delay is tied to mortality

  • Bembea MM & al.
  • Crit Care Med
  • 4 Feb 2019

  • curated by Jenny Blair, MD
  • Clinical Essentials
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  • Children experiencing cardiac arrest who undergo extracorporeal cardiopulmonary resuscitation (ECPR) have higher mortality if extracorporeal membrane oxygenation (ECMO) is delayed.

Why this matters

  • In 2015 American Heart Association (AHA) guidelines, evidence was insufficient to recommend or discourage routine ECMO during ECPR for children with noncardiac diagnoses experiencing in-hospital cardiac arrest (IHCA).  
  • ECPR is considered reasonable in children with cardiac diagnoses not achieving quick return of spontaneous circulation (ROSC), according to 2018 AHA recommendations. 
  • Still unknown:
    • Long-term outcomes for survivors; 
    • Influence of prearrest illness(es) on ECPR outcomes; 
    • Associations of outcomes with CPR quality; ECPR location, equipment, personnel, and center characteristics; and
    • Effects of neuroprotective strategies during ECPR.

Key results

  • Overall in-hospital mortality: 59.4%.
  • Factors predicting death (aORs; 95% CIs): 
    • Noncardiac diagnoses: 1.85 (1.19-2.89),
    • Renal insufficiency: 4.74 (2.06-10.9),
    • 5-minute increase from CPR onset to ECMO initiation: 1.04 (1.01-1.07), and
    • 2 adverse events during ECMO: 1.75 (1.023-2.995); aOR rose further with each additional event.

Study design

  • Analysis of 2 prospective registries, 2000-2014: Extracorporeal Life Support Organization and American Heart Association Get With the Guidelines-Resuscitation (n=593).
  • Authors sought factors predicting in-hospital mortality after ECPR for pediatric in-hospital cardiac arrest. 
  • Funding: NIH.


  • Possible unmeasured confounders.

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