This binational study demonstrates that a rapidly available sepsis mortality prediction model can define thresholds for survival benefit in children with septic shock considered for ECMO.

Survival on ECMO was associated with central cannulation.

The findings suggest that a fully powered RCT on ECMO in sepsis is unlikely to be feasible.

Retrospective binational multicenter cohort study of all ICUs contributing to the Australian and New Zealand Paediatric Intensive Care Registry.

Patients older than 16 years old admitted to ICU with sepsis and septic shock between 2002 and 2016 were included in the study.

5,062 children with sepsis and septic shock met eligibility criteria, of which 80 (1.6%) were treated with veno-arterial ECMO.

A model based on 12 clinical variables predicted mortality with an AUROC of 0.879.

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