Prolonged cardiopulmonary resuscitation and low flow state are not contraindications for extracorporeal support

Area of Science:

• Pediatric Critical Care Medicine
• Emergency Medicine
• Cardiology

Background:

• Out-of-hospital cardiac arrest (OHCA) in children has a dismal prognosis, with survival rates below 10%.
• Extracorporeal cardiopulmonary resuscitation (ECPR) is an emerging therapy to improve outcomes in select cases.
• Patient selection for ECPR is complex, influenced by arrest circumstances, resuscitation duration, and institutional resources.

Observation:

• We report a case of a pediatric patient experiencing an extremely prolonged out-of-hospital cardiac arrest.
• Mechanical chest compression devices were utilized during the extended resuscitation period.
• The patient was subsequently transitioned to extracorporeal membrane oxygenation (ECMO) for advanced circulatory and respiratory support.

Findings:

• This case demonstrates the potential utility of mechanical compression devices in prolonged resuscitation efforts.
• Successful transition to and utilization of ECMO following mechanical CPR in a pediatric OHCA patient.
• The case outcome offers insights into the management of refractory pediatric cardiac arrest.

Implications:

• This case may inform discussions on optimizing patient selection criteria for ECPR in pediatric refractory cardiac arrest.
• Further research is warranted to explore the role of mechanical circulatory support and ECPR in improving survival for pediatric OHCA.
• The findings encourage a broader consideration of advanced extracorporeal techniques in challenging pediatric resuscitation scenarios.