Update Course Rewind 2025: Pediatric ECPR: Who Should Receive Extracorporeal Cardiopulmonary Resuscitation?
With Dr. Juan Guerrilla & Dr. David Rothstein · hosted by Dr. Lizzie Lee
Part of
Cardiac Arrest 6 items
Chapter 1 of 5 · Fundamentals
ECPR introduction
Introduction to ECPR Decision-Making
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
ECPR is extracorporeal cardiopulmonary resuscitation, which adds ECMO (extracorporeal membrane oxygenation) to conventional CPR to increase outcomes.
Success in ECPR is defined as survival and favorable neurologic outcome.
ECPR candidates must have reversible pathology; ECMO is not a destination but a bridge to gain more time.
Not all out-of-hospital arrests are the same; some patients may have dismal presentation but reasonable numbers reflecting circulation, while others may have great community response but terrible numbers.
Good laboratory numbers may be more important than CPR downtime in ECPR candidacy assessment.
ECPR does not replace conventional CPR; it adds temporary heart and lung support while clinicians work to treat a potentially reversible cause of arrest.
Considerations for ECPR candidacy include likelihood of recovery, whether the underlying disease can be treated, equitable use of resources, and long-term follow-up.
Choosing the right patient may be the most important decision of the entire resuscitation.
A child who has had CPR for 30 minutes is not automatically a poor ECPR candidate.
ECPR is not simply reserved for the sickest patient; it is reserved for patients who still have a realistic chance of recovery if ECMO can buy enough time.
ECPR candidates have had a witnessed arrest, evidence that organs are still being perfused, and a chance that the underlying disease can be fixed.
Laboratory data such as pH, potassium, and evidence of circulation provide valuable context for ECPR decision-making.
Laboratory values and circulation evidence influence ECPR decision-making just as much as the duration of CPR.
Choosing the right ECPR patient is not about following one laboratory value or one time limit; reversible disease matters most.
Identifying patients most likely to benefit from ECPR requires combining physiology, clinical judgment, and preparation.