Unexpected survival after a prolonged extra-hospital refractory cardiac arrest in a one-year-old child

Extracorporeal membrane oxygenation (ECMO) during cardiac arrest resuscitation (E-CPR) is the last resort therapy in case of refractory cardiac arrest. Despite promising results in intra-hospital cardiac arrest (IHCA), the prognosis of extra-hospital cardiac arrest managed with E-CPR remain controversial, especially in children. We report a rare case of prolonged extra-hospital refractory cardiac after intentional drowning, in a region far from all ECMO center. The child was supported by veno-arterial (VA) ECMO after three and a half hours of CPR. VA ECMO switched to veno venous ECMO on day three. VV ECMO was weaned on day nine. Brain MRI identified a right frontoparietal ischemia and mild hemorrhage. Clinical follow-up 3 years after cardiac arrest showed a mild motor delay with paresis of the left lower limb. This case supports the necessity to take into consideration the possibility to propose E-CPR in refractory cardiac arrest after accidental drowning.