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Published on: January 17, 2025
Intermediate-term outcomes after paediatric cardiac extracorporeal membrane oxygenation--what is known (and unknown)
John M Costello1, David S Cooper, Jeffrey P Jacobs
1Children's Memorial Hospital, Feinberg School of Medicine, Northwestern University, 2300 Children's Plaza, Chicago, IL 60614, USA. jmcostello@childrensmemorial.org
Insights
Extracorporeal membrane oxygenation (ECMO) offers a lifeline for children with severe cardiac issues, but survival to discharge is only 40%. Long-term outcomes require further research and improved patient selection for better results.
Area of Science:
- Pediatric Cardiology
- Critical Care Medicine
- Cardiovascular Surgery
Background:
- Extracorporeal membrane oxygenation (ECMO) use is rising in pediatric cardiac patients with refractory cardiogenic shock, cyanosis, or arrest.
- Despite its life-saving potential, early mortality remains high, with only 40% of cannulated patients surviving hospital discharge.
Purpose of the Study:
- To evaluate the survival rates and long-term outcomes of pediatric cardiac patients requiring ECMO.
- To identify factors influencing morbidity and quality of life in survivors.
Main Methods:
- Retrospective analysis of pediatric cardiac patients treated with ECMO.
- Assessment of survival to discharge, intermediate-term survival, and long-term neurodevelopmental outcomes and quality of life.
Main Results:
- While 90% of discharged survivors are alive at intermediate follow-up, significant long-term risks include multi-organ dysfunction and neurological morbidity (10% with significant deficits).
- Approximately 15-30% of survivors experience moderately decreased quality of life.
- Neurological complications significantly impact outcomes in about one-third of survivors.
Conclusions:
- ECMO remains crucial for children with acute cardiac failure who would otherwise not survive.
- Improvements in patient selection and organ function preservation during ECMO are essential for enhancing long-term outcomes.
Abstract:
The use of extracorporeal membrane oxygenation in infants and children with cardiac disease who develop refractory cardiogenic shock, cyanosis, or cardiac arrest is increasing. Early mortality in children with cardiac disease who require extracorporeal membrane oxygenation remains an important issue, as only 40% of cannulated patients survive to discharge from the hospital. However, it is encouraging that 90% children who are discharged alive from the hospital after extracorporeal membrane oxygenation are still alive at intermediate-term follow-up. Surviving patients are at risk for long-term dysfunction of multiple organ systems related to their underlying cardiac disease, non-cardiac comorbidities, treatment-related complications, and exposure to extracorporeal membrane oxygenation. Among the most important acute complications related to support with extracorporeal membrane oxygenation is injury to the central nervous system, which may contribute to adverse neurodevelopmental outcomes. All of these factors, in turn, influence quality of life. Many survivors remain medically complex related to their underlying cardiac disease, comorbidities, and sequelae of complications acquired over their lifetime. Neurological morbidity clearly plays an important role in approximately one-third of survivors, with significant deficits in approximately 10%. The limited data about quality of life data that are available for survivors of cardiac extracorporeal membrane oxygenation suggests that approximately 15-30% of survivors have at least moderately decreased quality of life. Overall, published data support the ongoing use of support with extracorporeal membrane oxygenation in children with acute cardiac failure, most of whom would die without it. However, programmatic efforts to improve the selection of patients and the preservation of the function of end organs during extracorporeal membrane oxygenation are clearly needed in order to improve long-term outcomes.
