Schlapbach LJ, Chiletti R, Straney L, et al. - In order to report the benefit threshold of extracorporeal membrane oxygenation (ECMO) in pediatric septic shock, researchers undertook this retrospective binational multicenter cohort study. This investigation included all ICUs contributing to the Australian and New Zealand Paediatric Intensive Care Registry and ICU patients, < 16 years, with sepsis and septic shock. They conducted sepsis-specific risk-adjusted models to ascertain ECMO benefit thresholds with mortality as the primary outcome. An AUROC of 0.879 (95% CI 0.864–0.895) was generated for mortality prediction using a model based on 12 clinical variables. The benefit threshold was estimated as 47.1% predicted risk of mortality. The perceived mortality for children managed with ECMO below the threshold was 41.8% (23 deaths) than predicted mortality of 30.0% as per the baseline model. The factors that significantly predicted survival for those managed with VA (veno-arterial)-ECMO were lower lactate, the lack of cardiac arrest before ECMO, and the central cannulation, as revealed in multivariable analyses. It was shown in this binational study that thresholds for survival benefit in children with septic shock considered for ECMO can be defined using a rapidly available sepsis mortality prediction model. A link was identified between survival on ECMO and central cannulation. According to these results, a completely powered RCT on ECMO in sepsis is unlikely to be feasible.