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Neurodevelopmental Outcomes after Pediatric Cardiac ECMO Support
Constantinos Chrysostomou1, Timothy Maul2, Patrick M Callahan3
1Critical Care Medicine, Cardiac Intensive Care, Children's Hospital of Pittsburgh of UPMC , Pittsburgh, PA , USA.
Insights
Pediatric cardiac extracorporeal membrane oxygenation (ECMO) offers good survival rates and neurodevelopmental outcomes. Most survivors experience mild disability, with many showing neurologic improvement over time.
Area of Science:
- Pediatric Cardiology
- Neonatal Intensive Care
- Neurodevelopmental Outcomes
Background:
- Cardiac extracorporeal membrane oxygenation (ECMO) is a critical intervention for critically ill pediatric patients with cardiac disease.
- Understanding the long-term neurodevelopmental impact of ECMO is crucial for optimizing patient care.
Purpose of the Study:
- To characterize neurodevelopmental outcomes in pediatric cardiac ECMO patients.
- To identify factors associated with adverse neurodevelopmental outcomes.
Main Methods:
- A five-year retrospective review of pediatric cardiac ECMO patients.
- Analysis included demographics, cardiac lesion, surgical complexity, ECMO details, and complications.
- Neurodevelopmental status assessed using Pediatric Overall Performance Category and Pediatric Cerebral Performance Category Scales.
Main Results:
- Overall ECMO survival was 73% at discharge and 66% at follow-up.
- Moderate to severe disability at discharge linked to CPR, plasma exchange, or intracranial insults.
- Cerebral infarction was the sole predictor of neurological deterioration at later follow-up.
Conclusions:
- Pediatric cardiac ECMO demonstrates favorable short- and long-term survival rates.
- Most survivors exhibit normal to mild neurodevelopmental disability, with significant improvement noted.
- Comprehensive neuropsychological testing is essential for all pediatric ECMO survivors.
Purpose:
To characterize the neurodevelopmental outcomes and identify factors associated with poor outcomes in pediatric patients undergoing cardiac extracorporeal membrane oxygenation (ECMO).
Methods:
Five year retrospective review, including demographics, cardiac lesion, and surgical complexity, reason for ECMO, ECMO complications, and neurodevelopmental status at discharge and latest follow-up. Neurodevelopmental status was determined through the Pediatric Overall Performance Category and Pediatric Cerebral Performance Category Scales.
Results:
Overall ECMO survival was 73% at hospital discharge and 66% a t the latest follow-up. Most patients underwent cardiopulmonary resuscitation (CPR) (43%), and the majority (53%) had a significant disease complexity (Aristotle = 4). Complications occurred in 42% of the ECMO runs, of which 12% were intracranial injuries. At hospital discharge, 75% of patients had normal to mild disability, improving to 81% at 2 years follow-up. At hospital discharge, moderate to severe disability was associated with CPR, plasma exchange or intracranial insults. After discharge, 23% showed improvement in neurologic status and 4% showed deterioration. Cerebral infarction was the only parameter associated with deterioration at the later follow-up stage.
Conclusion:
Extracorporeal membrane oxygenation was successfully used in children with cardiac disease with 73 and 66% short and long-term survival respectively. Majority of the survivors had normal to mild neurodevelopmental disability and a significant portion showed neurologic improvement by the latest follow-up. Nevertheless, despite the grossly favorable outcomes standardized comprehensive neuropsychological testing is of paramount importance in all these patients.
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