The approach to extracorporeal cardiopulmonary resuscitation (ECPR) in children. A narrative review by the paediatric ECPR working group of EuroELSO.
H A MensinkA DesaiMirjana CvetkovicM DavidsonA HoskoteM O'CallaghanT ThiruchelvamPeter Paul RoeleveldPublished in: Perfusion (2024)
Extracorporeal Cardiopulmonary Resuscitation (ECPR) has potential benefits compared to conventional Cardiopulmonary Resuscitation (CCPR) in children. Although no randomised trials for paediatric ECPR have been conducted, there is extensive literature on survival, neurological outcome and risk factors for survival. Based on current literature and guidelines, we suggest recommendations for deployment of paediatric ECPR emphasising the requirement for protocols, training, and timely intervention to enhance patient outcomes. Factors related to outcomes of paediatric ECPR include initial underlying rhythm, CCPR duration, quality of CCPR, medications during CCPR, cannulation site, acidosis and renal dysfunction. Based on current evidence and experience, we provide an approach to patient selection, ECMO initiation and management in ECPR regarding blood and sweep flow settings, unloading of the left ventricle, diagnostics whilst on ECMO, temperature targets, neuromonitoring as well as suggested weaning and decannulation strategies.
Keyphrases
- cardiopulmonary resuscitation
- cardiac arrest
- intensive care unit
- extracorporeal membrane oxygenation
- emergency department
- systematic review
- young adults
- clinical trial
- acute respiratory distress syndrome
- heart failure
- pulmonary hypertension
- case report
- mechanical ventilation
- climate change
- mitral valve
- free survival
- quality improvement
- insulin resistance
- weight loss