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Neurodevelopmental outcome in ECMO vs near-miss ECMO patients at 5 years of age
K Rais-Bahrami1, A E Wagner, C Coffman
1Department of Neonatology, George Washington University School of Medicine, Washington, DC, USA.
Insights
Children treated with extracorporeal membrane oxygenation (ECMO) and critically ill children who narrowly missed ECMO treatment show similar neurodevelopmental outcomes at age five. Both groups face similar risks for school failure, necessitating close follow-up.
Area of Science:
- Pediatric Critical Care Medicine
- Neurodevelopmental Outcomes
- Extracorporeal Membrane Oxygenation (ECMO)
Background:
- Critically ill children require advanced life support, including Extracorporeal Membrane Oxygenation (ECMO).
- Understanding long-term neurodevelopmental outcomes for ECMO survivors and similar critically ill children is crucial for patient management and care.
- The 'near-miss ECMO' group provides a valuable comparison for assessing ECMO's specific impact.
Purpose of the Study:
- To compare the 5-year neurodevelopmental outcomes of children treated with ECMO versus those critically ill but not treated with ECMO (near-miss ECMO).
- To assess cognitive function, preacademic skills, adaptive behavior, and risk for school failure in both groups.
Main Methods:
- A cohort study comparing 76 five-year-old children treated with ECMO to 20 five-year-old near-miss ECMO patients with similar primary diagnoses.
- Neurodevelopmental assessment included intelligence (IQ) testing, preacademic/academic skills evaluation, and parent-reported adaptive behavior.
- Demographic data, ventilatory support, and hyperventilation were compared between groups.
Main Results:
- Both ECMO and near-miss ECMO groups exhibited similar demographic data and primary diagnoses.
- Cognitive outcomes were comparable, with mean Full-Scale IQ scores in the normal range (ECMO: 97, near-miss: 89).
- Rates of severe mental handicap (12% vs. 11%) and risk for school failure (37% vs. 38%) were similar. Parents reported more immature adaptive skills in the near-miss group, though numbers were small.
Conclusions:
- Children treated with ECMO and those who were critically ill but did not meet ECMO criteria (near-miss ECMO) demonstrate similar cognitive and adaptive outcomes at 5 years of age.
- A significant proportion of children in both groups are at risk for school failure, highlighting the need for ongoing monitoring and support.
- These findings suggest that factors beyond ECMO treatment itself significantly influence long-term neurodevelopmental trajectories in critically ill children.
Abstract:
The objective of this study was to compare the outcome of children at 5 years of age who were treated with extracorporeal membrane oxygenation (ECMO) and those who were critically ill but did not meet ECMO criteria, identified as near-miss ECMO. In one of the longest studies of its kind, we compared the neurodevelopmental outcome of 76 5-year-old ECMO-treated children with 20 5-year-old near-miss ECMO patients with similar primary diagnoses. The two groups were compared for demographic data, level of ventilatory support, and degree of hyperventilation. The comprehensive assessment protocol included an assessment of intelligence (IQ), attainment of preacademic and early academic skills, and parents' report of adaptive behavior. Both groups had similar demographic data and primary diagnosis. The near-miss ECMO patients required increased ventilatory support but not significantly more than the ECMO patients. The cognitive outcome was similar in both groups with mean estimated Full-Scale IQ in the normal range for near-miss and ECMO groups (89 and 97, respectively). Rates of severe mental handicap (FSIQ < 70) (near-miss = 11%, ECMO = 12%) and risk for school failure (near-miss = 38%, ECMO = 37%) were also similar. More parents of near-miss ECMO patients reported immature adaptive skills than did parents of ECMO patients, although the numbers were small in each group. Rates of parent-reported child behavior problems were similar in both groups. ECMO and near-miss ECMO patients have similar cognitive and adaptive outcomes at 5 years of age. A significant number in each group are at risk of school failure and should be closely followed up.