Which option best describes ECMO/ECPR prerequisites for pediatric arrest?

• A. In cases where there is no ECMO center available.
• B. Refractory arrest with reversible cause and a suitable center.
• C. Only in neonates.
• D. Any arrest regardless of reversibility.

Answer: (B)

The key idea is that ECMO/ECPR is considered only when there is a reversible cause for the arrest and a capable center is available to initiate ECMO. This means you’ve got a child in cardiac arrest that does not respond to high-quality CPR (refractory arrest) and there is a plausible, reversible reason for the collapse—such as myocarditis, pulmonary embolism, severe hypoxia, toxin ingestion, or a surgically correctable problem—and you can quickly get to a center with ECMO capability and a trained team to cannulate and support the patient.

If there is no ECMO-capable center nearby, initiating ECMO isn’t feasible, because effective ECMO support requires specialized resources and rapid cannulation that typical resuscitation teams don’t possess. It’s also not limited to neonates; pediatric ECMO/ECPR includes infants and older children who meet the criteria, so restricting to neonates would miss many appropriate cases. And it isn’t used for arrests with nonreversible causes, where bridging to recovery isn’t possible—even if ECMO could temporarily support circulation, without a reversible problem to fix, the overall outcome would remain poor.

So the best-fit description is a refractory arrest with a reversible cause and access to a suitable ECMO-capable center.