In this World Shared Practice Forum podcast, Dr. Dennis Daniel discusses pediatric extracorporeal life support (ECLS) with experts Drs. Peta Alexander and Ryan Barbaro. They explore the differences between pediatric and adult extracorporeal cardiopulmonary resuscitation (ECPR), highlighting differing causes of cardiac arrest and the interpretation of recently published studies. The discussion also covers supply chain issues affecting ECMO availability, the importance of standardized, evidence-based practices to identifying ECMO-associated complications, and opportunities for future research into ECMO use and outcomes.

LEARNING OBJECTIVES
- Identify the key differences between pediatric and adult extracorporeal cardiopulmonary resuscitation (ECPR), focusing on technical challenges and typical causes of cardiac arrest
- Discuss the challenges facing standardization of pediatric ECMO care, including supply chain issues and approaches to capturing and classifying ECMO-associated complications
- Describe areas of need and opportunity for future research in pediatric ECMO

AUTHORS
Peta Alexander, MBBS, FRACP, FCICM
Senior Associate Cardiologist
Director of ECMO Program
Boston Children’s Hospital
Associate Professor in Pediatrics
Harvard Medical School

Ryan Barbaro, MD, MSc
Service Chief of Pediatric Critical Care Medicine
Director of Pediatric ECMO
C.S. Mott Children's Hospital
Clinical Associate Professor in Pediatric Critical Care
University of Michigan

Dennis Daniel, MD
ECMO Medical Director, Medical-Surgical ICU
Associate Director, OPENPediatrics
Boston Children’s Hospital

DATE
Initial publication date: January 27, 2025.

ARTICLES REFERENCED AND ADDITIONAL RESOURCES
- Alexander PMA, Di Nardo M, Combes A, et al. Definitions of adverse events associated with extracorporeal membrane oxygenation in children: results of n international Delphi process from the ECMO-CENTRAL ARC. Lancet Child Adolesc Health. 2024;8(10):773-780. https://pubmed.ncbi.nlm.nih.gov/39299748/

- UK collaborative randomised trial of neonatal extracorporeal membrane oxygenation. UK Collaborative ECMO Trail Group. Lancet. 1996;348(9020):75-82. https://pubmed.ncbi.nlm.nih.gov/8676720/

- Biomarkers of Brain Injury in Critically-Ill Children on Extracorporeal Membrane Oxygenation (ECMOhttps://reporter.nih.gov/project-details/10545733

- TITRE - Trial of Indication-based Transfusion of Red Blood Cells in ECMO, https://www.childrenshospital.org/clinical-trials/nct05405426

- ASCEND study: https://chear.org/our-research/projects/ascend-ards-children-and-ecmo-initiation-strategies-impact-neuro-development

TRANSCRIPT
https://cdn.bfldr.com/D6LGWP8S/at/bzpc2445cxrk9zch4wqvjjs5/012525_WSP_Updates_in_Pediatric_ECMO.pdf

Please visit: http://www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children’s Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access, thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu

CITATION
Alexander PMA, Barbaro RP, Daniel D. Updates in Pediatric ECMO: Challenges and Opportunities. 01/2025. OPENPediatrics. Online Podcast. https://soundcloud.com/openpediatrics/updates-in-pediatric-ecmo-challenges-and-opportunities-by-p-alexander-r-barbaro-openpediatrics.

Updates in Pediatric ECMO: Challenges and Opportunities by P. Alexander, R. Barbaro | OPENPediatrics

In this World Shared Practice Forum Podcast, Dr. Graeme MacLaren shares his expert insight on the outcomes of central versus peripheral cannulation techniques for Extracorporeal Membrane Oxygenation (ECMO) in pediatric patients with refractory septic shock as published in the February issue of Pediatric Critical Care Medicine. The discussion focuses on the implications of ECMO modality choices, the conditions affecting cannulation strategy, and how institutional resources can impact patient outcomes.

LEARNING OBJECTIVES
- Differentiate between central and peripheral venoarterial ECMO strategies in pediatric septic shock
- Analyze key papers in the literature to provide context for decision-making around ECMO deployment in refractory septic shock
- Identify factors influencing the success and outcome of ECMO in refractory pediatric septic shock cases
- Apply considerations for patient selection and institutional resource availability in ECMO planning

AUTHORS
Graeme MacLaren, MBBS, MSc, FRACP, FCICM, FCCM, FELSO
Director of Cardiothoracic Intensive Care, 
National University Hospital, Singapore
Clinical Director of ECMO, National University Heart Centre, Singapore
Adjunct Professor, Department of Surgery, National University of Singapore
Past President, Extracorporeal Life Support Organization

Jeffrey Burns, MD, MPH
Emeritus Chief 
Division of Critical Care Medicine
Department of Anesthesiology, Critical Care and Pain Medicine 
Boston Children's Hospital
Professor of Anesthesia
Harvard Medical School

DATE
Initial publication date: March 24, 2025.

ARTICLES REFERENCED

1) MacLaren, Graeme MBBS, MSc, FELSO, FCCM. Cannulation Strategies for Extracorporeal Membrane Oxygenation in Children With Refractory Septic Shock. Pediatric Critical Care Medicine ():10.1097/PCC.0000000000003707, February 10, 2025. | DOI: 10.1097/PCC.0000000000003707

2) Totapally A, Stark R, Danko M, et al. Central or Peripheral Venoarterial Extracorporeal Membrane Oxygenation for Pediatric Sepsis: Outcomes Comparison in the Extracorporeal Life Support Organization Dataset, 2000-2021. Pediatr Crit Care Med. Published online January 23, 2025. doi:10.1097/PCC.0000000000003692

3) Schlapbach LJ, Chiletti R, Straney L, et al. Defining benefit threshold for extracorporeal membrane oxygenation in children with sepsis-a binational multicenter cohort study. Crit Care. 2019;23(1):429. Published 2019 Dec 30. doi:10.1186/s13054-019-2685-1

4) Bréchot N, Hajage D, Kimmoun A, et al. Venoarterial extracorporeal membrane oxygenation to rescue sepsis-induced cardiogenic shock: a retrospective, multicentre, international cohort study. Lancet. 2020;396(10250):545-552. doi:10.1016/S0140-6736(20)30733-9

TRANSCRIPT
https://cdn.bfldr.com/D6LGWP8S/at/84gbxthfmhvp7v9fsnjb87mh/0320425_WSP_MacLaren_Transcript.pdf

Please visit: http://www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children’s Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open-access thus at no expense to the user.

CITATION
MacLaren G, Burns JP. Pediatric ECMO Cannulation Strategies in Refractory Septic Shock. 03/2025. OPENPediatrics. https://soundcloud.com/openpediatrics/pediatric-ecmo-cannulation-strategies-in-refractory-septic-shock-by-g-maclaren-openpediatrics.

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