In congenital heart disease, resuscitation may require adjustments due to shunt physiology. Which statement is true?

• A. Shunt physiology is not a concern during pediatric resuscitation.
• B. Shunt physiology must be considered; advanced hemodynamic management may be required.
• C. Shunt physiology must be considered; may require advanced hemodynamic management and consideration for ECPR.
• D. ECPR is contraindicated.

Answer: (C)

In congenital heart disease, shunt physiology can dramatically change how blood moves during resuscitation, so standard pediatric CPR may not achieve adequate perfusion. When there are abnormal connections or single-ventricle pathways, systemic blood flow depends on the balance between systemic vascular resistance and pulmonary blood flow, and how ventilation and oxygenation affect these pressures. Because of this, you often need more than just chest compressions—you may require targeted, advanced hemodynamic management with careful use of inotropes and vasopressors, adjustments to ventilation to avoid worsening pulmonary or systemic pressures, and, in some cases, consideration of extracorporeal life support (ECPR) to provide reliable systemic perfusion while definitive cardiac issues are addressed.

That’s why this option is the most accurate: it acknowledges the need to account for shunt physiology and the potential role of advanced hemodynamic support and ECPR.