**5. Conclusions**

Many of the recommendations regarding CPR quality metrics in children are based on extrapolation of adult and animal data, given the scarcity of pediatric literature. Although current AHA guidelines focus on "provider"-centric CPR, the evidence for transitioning to a "patient"-centric guided CPR is growing. Along with CPR quality, the choice of the right medications and dosing intervals is critical during a pediatric cardiac arrest and is also a field of pediatric resuscitation that is lacking evidence. Despite good-quality CPR, there are many times when ROSC does not occur. Although PALS guidelines state that ECPR can be considered in certain circumstances, there are still gaps in the literature regarding cannulation strategies and resuscitation practices during ECPR. After successful ROSC or return of circulation after ECPR, the medical management of a child is critical to ameliorate the effects of PCAS and prevent further injury to vital organs, in particular the brain.
