Pediatric ECMO after drowning: Neuroprotective strategies

There are no established neuroprotective guidelines during pediatric extracorporeal membrane oxygenation (ECMO) after cardiac arrest. We report a case of unknown duration, out-of-hospital cardiac arrest after drowning in a toddler. The patient experienced severe cardiopulmonary failure shortly after return of spontaneous circulation and required veno-arterial ECMO. Clinical outcome was excellent. This report outlines a neuroprotective strategy using high-dose erythropoietin, dexmedetomidine, and therapeutic hypothermia that was implemented during ECMO. Risk factors related to pediatric drowning with cardiac arrest are also discussed.