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Pediatric Extracorporeal Cardiopulmonary Resuscitation (ECPR): Understanding Variations in Systems and Clinical
Maura O'Callaghan1, Jan Belohlavek2, Mirjana Cvetkovic3
1From the Extracorporeal Membrane Oxygenation (ECMO), Great Ormond Street Hospital for Children, London, UK.
Insights
Extracorporeal cardiopulmonary resuscitation (ECPR) practices vary significantly among pediatric extracorporeal membrane oxygenation (ECMO) centers. This study highlights differences in systems and clinical approaches for pediatric cardiac arrest, impacting patient care.
Area of Science:
- Pediatric Critical Care Medicine
- Cardiovascular Surgery
- Extracorporeal Life Support
Background:
- Extracorporeal cardiopulmonary resuscitation (ECPR) requires specialized resources and rapid decision-making for pediatric cardiac arrest.
- Significant variations in ECPR systems and clinical practices may influence patient outcomes.
Purpose of the Study:
- To evaluate the heterogeneity in systems and clinical practices among extracorporeal membrane oxygenation (ECMO) centers offering ECPR for neonatal and pediatric patients.
- To identify variations in ECPR protocols, staffing, and patient populations across different ECMO centers.
Main Methods:
- An online survey was distributed to 53 ECMO centers across all five Extracorporeal Life Support Organization (ELSO) chapters.
- The survey assessed ECPR definitions, patient demographics, team activation times, circuit availability, institutional protocols, cannulation practices, staffing, temperature management, and follow-up guidelines.
Main Results:
- All surveyed centers shared a common understanding of ECPR definition.
- Significant variations were observed in ICU patient populations, ECPR team activation protocols, 24/7 primed circuit availability (64%), and institutional ECPR protocols (68%).
- Practices regarding temperature management (71% did not apply cooling), oxygenation/CO2 strategies, and guidelines for organ donation/neurodevelopmental follow-up (44%) showed considerable differences.
Conclusions:
- Substantial variations exist in the systems and clinical practices of ECMO centers providing pediatric ECPR.
- Further research is warranted to elucidate the reasons behind these discrepancies and their impact on patient outcomes in pediatric ECPR.
- Standardization of ECPR protocols and further investigation into best practices are crucial for improving care for pediatric patients experiencing cardiac arrest.
Abstract:
Extracorporeal cardiopulmonary resuscitation (ECPR) for pediatric cardiac arrest relies on enhanced resources and time-critical decision-making. We aimed to evaluate variations in systems and clinical practice among extracorporeal membrane oxygenation (ECMO) centers that offer ECPR for neonatal and pediatric patients using an online survey. Fifty-three ECMO centers participated, representing all five ELSO chapters. All centers had a similar understanding of the ECPR definition. The predominant intensive care unit (ICU) patient population was: cardiac (34%), mixed (51%), general (7.5%), neonatal (1%), and mixed adult and pediatric (6.5%). All centers activated ECPR teams within 10 minutes of starting conventional CPR. Thirty-four (64%) centers keep a primed circuit available for ECPR 24/7. Thirty-six (68%) centers have an institutional protocol on ECPR. The cardiac surgeon was the most common (94%) cannulator. Staffing levels varied during working hours compared to nights and weekends. Thirty-eight (71%) centers did not apply cooling measures during and after the initiation of ECPR. Oxygenation and CO2 strategy varied between centers upon ECMO flow commencement. Forty-two (81%) centers aimed to maintain normothermia and avoid hyperthermia. Twenty-three (44%) centers have guidelines on organ donation and neurodevelopmental follow-up. Conclusion-significant variations exist in systems and clinical practice among ECMO centers offering pediatric ECPR. Further research is needed to understand the reasons for these differences and their impacts on patient outcomes.
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