Extracorporeal cardiopulmonary resuscitation (ECPR) is an advanced therapy for refractory pediatric cardiac arrest. This review outlines the clinical and organizational components necessary to implement and sustain a successful pediatric ECPR program. Registry analyses and updated resuscitation guidelines emphasize the importance of minimizing low-flow time, optimizing cardiopulmonary resuscitation (CPR) quality, and rapidly deploying ECPR in select patients. Shorter CPR duration and lower post-cannulation lactate are associated with improved outcomes, highlighting the need for formalized activation pathways and efficient team dynamics. Evidence supports the use of standardized protocols, predefined team roles, equipment bundling, and simulation-based training to reduce time to cannulation and improve reliability. Human factors and systems engineering frameworks, including the Systems Engineering Initiative for Patient Safety (SEIPS) model, provide structured approach to aligning personnel, tasks, technology, environment, and organizational processes across the continuum of ECPR care. ECPR is a complex, time-sensitive therapy that requires deliberate programmatic development to translate technical capability into meaningful survival and neurologic outcomes. Institutions seeking to offer ECPR should adopt structured activation criteria, simulation-based systems testing, and ongoing performance evaluation to ensure safe, timely, and effective delivery.
Atlas et al. (Thu,) studied this question.