Introduction: The 2009 H1N1 pandemic resulted in a substantial increase in the use of extracorporeal cardiopulmonary resuscitation (ECPR). The concurrent release of guidelines by the French Ministry of Health also led to the standardization of ECPR protocol. We conducted a systematic review and meta-analysis to examine if the simultaneous development of guidelines and expanded usage led to an increase in survival to hospital discharge (SHD) in pediatric ECPR and to investigate if predictors of survival have changed since 2009. Methods: PubMed, SCOPUS, Google Scholar, Cochrane, and EMBASE were searched to identify studies examining survival outcome and predictors of survival for pediatric ECPR. A random-effects model was applied. Additional pre-specified subgroup analysis was performed using a fixed-effects model. A univariate meta-regression analysis was conducted. Results: The meta-analysis included 3,454 patients from 30 studies. Total survival rates have not improved in pediatric ECPR between subgroups (Mann-Whitney U test: p > 0.05). Extracorporeal membrane oxygenation (ECMO) duration for survivors was not significantly different than nonsurvivors before 2009 RR -0.02 [95% CI: -0.19 - 0.14], but was significantly lower than nonsurvivors after 2009 RR -0.32 [-0.48 - -0.15, p < 0.05]. Meta-regression analysis revealed the ratio of ECMO duration for survivors compared to non-survivors has significantly decreased from 1998 to 2020 (p < 0.05). Patient age was a significant predictor of survival pre-2009 RR but is not correlated with survival post-2009 (p > 0.05). PaO2 was significantly higher in survivors than nonsurvivors pre-2009 RR 0.15 [0.12 - 0.18, p < 0.05] but was not significantly different post-2009 (p > 0.05). End-tidal CO2, CPR duration, pre-CPR serum lactate, and pre-CPR creatinine were not significantly different (p > 0.05) between survivors and non-survivors in either pre-2009 or post-2009. Conclusion: Pediatric ECPR did not see major improvement in survival rates since 2009. In addition, predictors of survival for pediatric ECPR cases have changed over the last 10 years. As such, clinicians may be advised to rely much more heavily on recent research regarding predictors of survival in pediatric ECPR cases.