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Successful prehospital extracorporeal cardiopulmonary resuscitation in pediatric cardiac arrest - a case report

Year: 2025

Type: article

Abstract: INTRODUCTION: Cardiac arrest in children necessitates a systematic approach, including Basic Life Support, Advanced Life Support and post-resuscitation care. Extracorporeal Cardiopulmonary Resuscitation offers a viable option for refractory cardiac arrest by providing hemodynamic support through extracorporeal circulation. While prehospital E-CPR in pediatric patients remains rare, two cases were reported in the Netherlands in 2023, demonstrating feasibility despite poor outcomes. We present the first documented case of pediatric prehospital E-CPR in Germany, conducted as part of the Klinikum Stuttgart extracorporeal membrane oxygenation program, showcasing its implementation in an urban setting. CASE PRESENTATION: A 16-year-old patient with known hypertrophic non-obstructive cardiomyopathy suffered a cardiac arrest following exertion. After unsuccessful conventional resuscitation, prehospital ECMO cannulation was initiated. Cannulation was performed without complications (15 French (23 cm arterial, 25 Fr 55 cm venous), achieving a flow rate of 4500 mL/min and stable hemodynamics. Echocardiography revealed a significantly thickened septal wall and impaired ejection function. During transport under ECMO support, spontaneous movements and breathing were observed, managed with sedation and lung-protective ventilation. OUTCOME: Upon hospital admission, whole-body CT revealed only free intraperitoneal fluid consistent with anasarca, without vascular or cannulation-related complications. The patient was weaned from ECMO and extubated after 48 h, developing transient mild delirium and aspiration pneumonia, both resolved. An ICD was implanted for secondary prevention, and the patient was discharged neurologically intact (cerebral performance category 1). CONCLUSION: Given the limited availability of pediatric E-CPR and the challenges of long transport distances, structured prehospital E-CPR programs with specialized teams may provide a viable solution for critically ill pediatric patients.

Source: Scandinavian Journal of Trauma Resuscitation and Emergency Medicine

DOI: 10.1186/s13049-025-01505-0