Pediatric extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest: outcomes and clinical trajectories

doi:10.1016/j.resuscitation.2026.111263

Acute cardiac care & resuscitationCohort study

Pediatric extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest: outcomes and clinical trajectories

ResuscitationPublished 15 Aug 2026

retrospective single-center observational cohort study
all consecutive children

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Authors' conclusion

Pediatric OHCA-ECPR yielded limited but meaningful survival. Measures of early resuscitation quality, low-flow duration, and early metabolic and organ-injury profiles may help distinguish different clinical trajectories after pediatric OHCA-ECPR.

Study context

Population: Children (<18 years) treated with extracorporeal cardiopulmonary resuscitation (ECPR) for OHCA at a tertiary pediatric ECMO referral center between 1 January 2013 and 31 December 2025underwent ECPR, of 155 pediatric OHCA patients managed at the institution
Participants: 42 children

Exposure: Survivors were compared with non-survivors, and among non-survivors, patients with brain death diagnosis were compared with those without brain death diagnosis.
survivorsn = 8
non-survivorsn = 34

Main finding

As reported in the abstract

Survival to hospital discharge

19.0% (8/42)

Observational data: associations, not effects.

Further findings

Bystander CPR · exploratory comparisons

P = 0.016

survivors100.0%

non-survivors52.9%

Transient pre-hospital ROSC · exploratory comparisons

P = 0.031

survivors62.5%

non-survivors20.6%

Low-flow duration · shorter in survivors · exploratory comparisons

P = 0.006

survivors53 min

non-survivors90 min

Initial lactate · lower in survivors

P = 0.003

survivors11.18 mmol/L

non-survivors18.00 mmol/L

Transfusion burden · 24-h · lower in survivors

P = 0.029

survivors12 mL/kg

non-survivors40 mL/kg

Outcome	survivors	non-survivors	P value
Vasoactive-inotropic score · 24-h · lower in survivors	5	18	P = 0.0053

Long-term survival and neurological outcome · last follow-up (median, 412 days)

hospital survivors alive: 7 of 8
of the 7 alive, PCPC ≤2: 6 of 7

Cohort characteristics

Median age: 9 years
median low-flow time: 85 min
median ECMO duration: 55 h

Early organ injury

Non-survivors had more severe and persistent early organ injury

Brain death diagnosis and organ donation

brain death diagnosis, of 34 deaths: 12
share of non-survivors: 35.3%
share of the total cohort: 28.6%
effective organ donors: 4

Original publication

Pediatric extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest: outcomes and clinical trajectories. Resuscitation. Published 15 August 2026. doi:10.1016/j.resuscitation.2026.111263

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Summarised from the published abstract; every number is checked against it