Extracorporeal cardiopulmonary resuscitation after pediatric cardiac surgery

We genuinely appreciate Erek et al. (1) for their study. Extracorporeal cardiopulmonary resuscitation (ECPR) has become a widely used procedure in cardiac arrest situations. The authors should definitely admit this procedure if they use cardiac arrest after pediatric cardiac surgery, a highly catastrophic condition. We believe that their results are very successful considering that the rate of post-cardiopulmonary bypass without cardiac arrest after discharge from the hospital is 20%–45% (2-4). However, we want to comment on a different topic. We believe that some obvious complications could have developed because of cannulation sites utilized by the authors. Because the ascending aorta is placed in the outlet cannula, left ventricular failure can be triggered by increasing afterload. Heart failure after ECPR is almost inevitable because of systemic phenomena caused by heart failure due to cardiac arrest in patients in the study by Erek et al. (1). Our questions to Erek et al. (1) are focused on this stage. If the causes of cardiac arrest in patients can be determined, what is the rate of heart failure in these patients? Further, if heart failure occurs, does it affect survival after ECPR? We would be very grateful if the authors have any explanation for these questions.