**8.4 Limitations**

ECPR remains a niche procedure that requires trained staff and resources, both of which are only available in tertiary centers with vital ECMO programs. Another problem is deciding which patients should receive ECPR, as the etiology alone is insufficient to foretell survival using ECPR. More multi-institutional studies are necessary to develop better guidelines for ECPR [71]. Presently, ECPR use is mainly limited to the pediatric population as most of the etiology is linked to congenital pathologies and may see better outcomes if ECMO buys enough time for recovery from postcardiotomy myocardial stunning, a transplant, or corrective procedure [72, 73].
