Characteristics of pediatric non-cardiac eCPR programs in United States and Canadian hospitals: A cross-sectional survey

Objective: To characterize practices surrounding pediatric eCPR in the U.S. and Canada.Methods: Cross-sectional survey of U.S. and Canadian hospitals with non-cardiac eCPR programs. Vari-ables included hospital and surgical group demographics, eCPR inclusion/exclusion criteria, cannulation approaches, and outcomes (survival to decannulation and survival to discharge).Results: Surveys were completed by 40 hospitals in the United States (37) and Canada (3) among an estimated 49 programs (82% response rate). Respondents tended to work in > 200 bed free-standing chil-dren's hospitals (27, 68%). Pediatric general surgeons respond to activations in 32 (80%) cases, with a me-dian group size of 7 (IQR 5,9.5); 8 (20%) responding institutions take in-house call and 63% have a formal back-up system for eCPR. Dedicated simulation programs were reported by 22 (55%) respondents. Annual eCPR activations average approximately 6/year; approximately 39% of patients survived to decannulation, with 35% surviving to discharge. Cannulations occurred in a variety of settings and were mostly done through the neck at the purview of cannulating surgeon/proceduralist. Exclusion criteria used by hospi-tals included pre-hospital arrest (21, 53%), COVID + (5, 13%), prolonged CPR (18, 45%), lethal chromosomal anomalies (15, 38%) and terminal underlying disease (14, 35%).Conclusions: While there are some similarities regarding inclusion/exclusion criteria, cannulation location and modality and follow-up in pediatric eCPR, these are not standard across multiple institutions. Sur-vival to discharge after eCPR is modest but data on cost and long-term neurologic sequela are lacking. Codification of indications and surgical approaches may help clarify the utility and success of eCPR.Level of evidence: 4 (c) 2022 Elsevier Inc. All rights reserved.