Pediatric anesthesia & critical care
Outcomes in pediatric extracorporeal cardiopulmonary resuscitation (ECPR) for in-hospital cardiac arrest: an Extracorporeal Life Support Organization (ELSO) registry analysis
Authors' conclusion
Pediatric ECPR is a complex, resource-intensive intervention impacted by institutional expertise, patient selection, arrest characteristics, and post-ECPR management.
Study context
- Population
- Patients up to 18 years with witnessed in-hospital cardiac arrest and ECPR, ELSO Registry, January 2020–October 2024
- Participants
- 1,903 participants
- Exposure
- Cardiac vs Non-cardiac vs Unknown
- Cardiacn = 1,410reference
- Non-cardiacn = 358
- Unknownn = 135
- Outcome
- Composite of:
- Survival to hospital discharge
- Heart transplantation
- Permanent ventricular assist device
Methodological detailsELSO Registry
- ELSO Registry
Main finding
As reported in the abstract
Favorable composite outcome
- Overall favorable composite outcome
- 788 (41.4 %)
Observational data: associations, not effects.
Further findings
Predictors of favorable outcome, univariate analysis
- Non-cardiac event, OR
- 0.46 [0.36-0.60]
- Longer cardiopulmonary resuscitation (CPR) duration, OR
- 0.98 [0.98-0.99]
- Non-shockable rhythm, OR
- 0.62 [0.49-0.79]
- Higher lactate, OR
- 0.95 [0.93-0.97]
- Signs of life, OR
- 1.52 [1.22-1.89]
- Higher pH, OR
- 3.26 [2.03-5.27]
Independent predictors of favorable outcome, multivariate analysis
- Higher pH at 24 h, OR
- 10.69 [1.46-78.36]
- Prior ECMO run, OR
- 0.37 [0.22-0.62]
- Lung disease, OR
- 0.37 [0.16-0.85]
- Renal replacement therapy, OR
- 0.39 [0.16-0.94]
- Higher PaCO2 prior to ECMO, OR
- 0.99 [0.99-0.99]
- Higher lactate at 24 h, OR
- 0.80 [0.75-0.85]
- Longer CPR time, OR
- 0.99 [0.99-0.99]
Elevated lactate tertiles (pre-ECPR, 6 h, 24 h) and favorable outcome
- Lower rates of favorable outcome, Kaplan-Meier
- p log-rank < 0.0001
- Lower rates of favorable outcome, Joint model
- P = 0.018
Original publication
Outcomes in pediatric ECPR for in-hospital cardiac arrest: an ELSO registry analysis. Resuscitation. Published 30 August 2025. doi:10.
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