Presenter Status
Resident/Psychology Intern
Abstract Type
Clinical Research
Primary Mentor or Principal Investigator
Jenna Miller
Presentation Type
Poster
Start Date
20-5-2026 12:00 PM
End Date
20-5-2026 1:00 PM
Abstract Text
Background
Pediatric out-of-hospital cardiac arrest (OHCA) remains a high-mortality event, with survival to discharge consistently below 10%. Although extracorporeal cardiopulmonary resuscitation (E-CPR) improves outcomes for in-hospital cardiac arrest, its application in the pre-hospital environment is not well defined for pediatrics. Identifying which pediatric patients might benefit from OHCA ECPR activation is essential for developing feasible pre hospital pediatric E-CPR systems. Preliminary analysis of applying criteria for adult OHCA ECPR activation can provide a crucial next step in establishing feasibility and applicability for the pediatric patient population.
Methods
A single center retrospective review was conducted of pediatric OHCA cases presenting from 2018–2025. Extracted data included demographics, initial rhythm, witnessed status, bystander CPR, pre-hospital interventions, transport time, prior cardiac surgery, and survival outcomes. Shockable rhythms Ventricular Tachycardia (VT)/Ventricular Fibrillation, (VF) and EMS-to-hospital transport times ≤30 minutes were analyzed as indicators of potential field E-CPR eligibility. Patients were considered potential OHCA ECPR activation candidates if they had witnessed arrest and were < 30 minutes from our institution AND they met one of the following indication criteria. Indication criteria included 1) adult OCHA ECPR criteria of VT/VF cardiac arrest, 2) history of congenital heart disease or 3) cardiac arrest at athletic event. Indications #2 and 3 were used based on historical institutional experience with this patient type.
Results
161 OHCA cases were identified. Demographics and etiology or arrested in Table1. Using our indication criteria, we were able to make the eligibility determination for 150 of the patients and of those, we found that 7 (4.7%, 95% CI: 1.3% - 8.0%) were eligible for potential OHCA ECPR activation process. Retrospective application of ECMO criteria identified additional non-survivors who exhibited favorable features including witnessed arrest, immediate CPR, and maintained perfusing attempts, suggesting potential benefits had E-CPR been available. Eleven patients (6.8%) had shockable initial rhythms; with 10/11 (91%) arriving within 30 minutes. Survival among this subgroup was substantially higher (73%) compared with non-shockable rhythms (< 15%). Key delays identified included inconsistent recognition of refractory arrest and absence of standardized activation pathways.
Conclusion
Few pediatric patients in our metro qualified for OHCA ECPR activation applying adult criteria currently published. Even with the addition of criteria utilized due to institutional history of these OHCA types, few patients qualified. Additional internal and external evaluation of pediatric OHCA data is warranted to determine alternative criteria that could identify more patients who may potentially benefit from pediatric OHCA ECPR activation.
Identifying Candidates for Field Extracorporeal Cardiopulmonary Resuscitation (E-CPR) in Pediatric Out-of-Hospital Cardiac Arrest: A Retrospective Review
Background
Pediatric out-of-hospital cardiac arrest (OHCA) remains a high-mortality event, with survival to discharge consistently below 10%. Although extracorporeal cardiopulmonary resuscitation (E-CPR) improves outcomes for in-hospital cardiac arrest, its application in the pre-hospital environment is not well defined for pediatrics. Identifying which pediatric patients might benefit from OHCA ECPR activation is essential for developing feasible pre hospital pediatric E-CPR systems. Preliminary analysis of applying criteria for adult OHCA ECPR activation can provide a crucial next step in establishing feasibility and applicability for the pediatric patient population.
Methods
A single center retrospective review was conducted of pediatric OHCA cases presenting from 2018–2025. Extracted data included demographics, initial rhythm, witnessed status, bystander CPR, pre-hospital interventions, transport time, prior cardiac surgery, and survival outcomes. Shockable rhythms Ventricular Tachycardia (VT)/Ventricular Fibrillation, (VF) and EMS-to-hospital transport times ≤30 minutes were analyzed as indicators of potential field E-CPR eligibility. Patients were considered potential OHCA ECPR activation candidates if they had witnessed arrest and were < 30 minutes from our institution AND they met one of the following indication criteria. Indication criteria included 1) adult OCHA ECPR criteria of VT/VF cardiac arrest, 2) history of congenital heart disease or 3) cardiac arrest at athletic event. Indications #2 and 3 were used based on historical institutional experience with this patient type.
Results
161 OHCA cases were identified. Demographics and etiology or arrested in Table1. Using our indication criteria, we were able to make the eligibility determination for 150 of the patients and of those, we found that 7 (4.7%, 95% CI: 1.3% - 8.0%) were eligible for potential OHCA ECPR activation process. Retrospective application of ECMO criteria identified additional non-survivors who exhibited favorable features including witnessed arrest, immediate CPR, and maintained perfusing attempts, suggesting potential benefits had E-CPR been available. Eleven patients (6.8%) had shockable initial rhythms; with 10/11 (91%) arriving within 30 minutes. Survival among this subgroup was substantially higher (73%) compared with non-shockable rhythms (< 15%). Key delays identified included inconsistent recognition of refractory arrest and absence of standardized activation pathways.
Conclusion
Few pediatric patients in our metro qualified for OHCA ECPR activation applying adult criteria currently published. Even with the addition of criteria utilized due to institutional history of these OHCA types, few patients qualified. Additional internal and external evaluation of pediatric OHCA data is warranted to determine alternative criteria that could identify more patients who may potentially benefit from pediatric OHCA ECPR activation.
Comments
Poster Board Number: 16