Clinical and psychosocial follow-up study of children treated with extracorporeal membrane oxygenation
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Kari Wagner1, Ivar Risnes, Torhild Berntsen
1Department of Anaesthesiology, Rikshospitalet-Radiumhospitalet Medical Centre, Oslo, Norway. kari.wagner@rikshospitalet.no
Insights
Children surviving extracorporeal membrane oxygenation (ECMO) often experience significant neurodevelopmental impairments. Long-term follow-up is crucial to assess outcomes and provide necessary support for these children.
Area of Science:
- Pediatric critical care medicine
- Neuroscience
- Developmental pediatrics
Background:
- Extracorporeal membrane oxygenation (ECMO) is a life-support technology for severe heart and pulmonary failure in children.
- A long-term follow-up study was conducted to assess outcomes in pediatric ECMO survivors.
- The study period spanned from 1991 to 2004 at a single institution.
Purpose of the Study:
- To perform a multimodal assessment of the outcomes in children who survived ECMO.
- To identify the prevalence of neurological, cognitive, and radiological sequelae in pediatric ECMO survivors.
- To evaluate the quality of life and parental satisfaction with ECMO treatment.
Main Methods:
- A cohort of 22 children, initiated on ECMO at an average age of 1.18 years, were followed up.
- Data collection involved a review of medical records, clinical examinations, neurological and neuropsychological assessments, electroencephalograms (EEGs), and radiological imaging.
- Parental interviews were conducted to gather subjective assessments of the child's quality of life and treatment satisfaction.
Main Results:
- 72.7% of children exhibited moderate to severe impairment in at least two clinical assessments.
- Significant neurodevelopmental deficits were common, including cerebral palsy (22.7%) and severe cognitive impairment (68.2%).
- Pathological findings were frequent on EEG (50%) and radiological examinations (36%), though not consistently associated with cognitive outcomes.
Conclusions:
- Despite frequent neurological and cognitive sequelae, most children achieved ambulation and reported a good quality of life.
- Parental satisfaction with ECMO treatment was high, with most reporting a good or slightly reduced quality of life.
- There is a clear need for targeted assessment and support to optimize the physical and psychosocial functioning of pediatric ECMO survivors.
Background:
Serious heart and pulmonary failure may be treated with extracorporeal membrane oxygenation (ECMO). The aim of this follow-up study was a multimodal assessment of outcome in children surviving ECMO at our hospital from 1991 to 2004.
Methods:
Twenty-two children were, on average, 1.18 years old (SD = 1.92; range, 0.1 to 7.8) when ECMO was initiated. Average age at follow-up was 7.2 years (range, 1.8 to 13.9). Thirteen children were treated for cardiac and nine for pulmonary failure. Venoarterial ECMO was performed in 21 patients and venovenous ECMO in one patient. The protocol included a review of patients records, clinical, neurologic and neuropsychologic, and radiological examinations, electroencephalogram, and interviews with the parents.
Results:
Moderate or severe impairment in at least two clinical assessments were found in 16 (72.7%) children. Five (22.7%) children had cerebral palsy and 15 (68.2%) had moderate or severe cognitive impairment. Eight (36%) children had pathological radiologic findings. Pathological electroencephalograms were found in 11 (50%) patients including four (18.2%) with epileptic activity. Children with radiologic findings had a slightly worse cognitive outcome. There was no association between the neurophysiologic findings and the neuropsychologic performance or the radiologic findings. Based on parental assessment, only four children had pathological scores.
Conclusions:
All children, except for two, came walking to the follow-up visit. All parents were positive to the ECMO treatment, and reported a good or slightly reduced quality of life for their child. Cerebral sequelae were frequently found in children treated with ECMO. The need for treatment and support should be assessed in order to optimize their physical and psychosocial functioning.
