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Functional Status of Neonatal and Pediatric Patients After Extracorporeal Membrane Oxygenation
Katherine Cashen1, Ron Reeder, Heidi J Dalton
11Division of Critical Care, Department of Pediatrics, Children's Hospital of Michigan/Wayne State University, Detroit, MI. 2Department of Pediatrics, University of Utah, Salt Lake City, UT. 3Department of Child Health, Phoenix Children's Hospital, Phoenix, AZ. 4Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, PA. 5Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI. 6Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA. 7Department of Pediatrics, Children's National Medical Center, Washington, DC. 8Department of Critical Care Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA. 9Department of Pediatrics, Mattel Children's Hospital UCLA, Los Angeles, CA. 10Pediatric Trauma and Critical Illness Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
Insights
Extracorporeal membrane oxygenation (ECMO) survivors often have abnormal functional status at discharge. Factors like renal failure, chronic conditions, and ECMO duration impact outcomes and mortality in pediatric and neonatal patients.
Area of Science:
- Pediatric Critical Care Medicine
- Neonatal Medicine
- Cardiovascular Surgery
- Extracorporeal Life Support
Background:
- Extracorporeal membrane oxygenation (ECMO) is a life-saving therapy for critically ill neonates and children.
- Understanding functional status post-ECMO is crucial for long-term outcomes.
- Factors influencing functional status and mortality require further investigation.
Purpose of the Study:
- To evaluate the functional status of neonatal and pediatric patients at hospital discharge after ECMO treatment.
- To identify patient- and ECMO-related factors associated with functional status.
- To identify factors associated with mortality in this patient population.
Main Methods:
- Secondary analysis of observational data from the Collaborative Pediatric Critical Care Research Network (CPCCRN).
- Study included 514 patients under 19 years old treated with ECMO between December 2012 and September 2014.
- Functional status assessed using the Functional Status Scale (FSS) among survivors.
Main Results:
- Of 514 patients, 267 were neonates. Respiratory and cardiac indications were most common.
- Among 282 survivors, 32% had good, 40% mildly abnormal, 24% moderately abnormal, and 5% severely/very severely abnormal FSS scores.
- Factors associated with worse FSS included renal failure and longer hospitalization (neonates), and chronic neurologic conditions and longer ICU stay (pediatrics).
- Mortality was linked to chronic conditions, prematurity, venoarterial ECMO, red cell transfusion, and ECMO duration (neonates); and chronic cardiac conditions, hepatic dysfunction, and neurologic complications (pediatrics).
- Achieving lactate <= 2 mmol/L during ECMO was associated with survival in both groups.
Conclusions:
- Approximately half of ECMO survivors exhibit good, mildly, or moderately abnormal functional status at discharge.
- Both patient-specific and ECMO-related factors significantly influence functional status and mortality.
- Optimizing care during ECMO may improve long-term functional outcomes for pediatric and neonatal patients.
Objectives:
To describe functional status at hospital discharge for neonatal and pediatric patients treated with extracorporeal membrane oxygenation, and identify factors associated with functional status and mortality.
Design:
Secondary analysis of observational data collected by the Collaborative Pediatric Critical Care Research Network between December 2012 and September 2014.
Setting:
Eight hospitals affiliated with the Collaborative Pediatric Critical Care Research Network.
Patients:
Patients were less than 19 years old and treated with extracorporeal membrane oxygenation.
Interventions:
Functional status was evaluated among survivors using the Functional Status Scale. Total Functional Status Scale scores range from 6 to 30 and are categorized as 6-7 (good), 8-9 (mildly abnormal), 10-15 (moderately abnormal), 16-21 (severely abnormal), and greater than 21 (very severely abnormal).
Measurements And Main Results:
Of 514 patients, 267 (52%) were neonates (≤ 30 d old). Indication for extracorporeal membrane oxygenation was respiratory for 237 (46%), cardiac for 207 (40%), and extracorporeal cardiopulmonary resuscitation for 70 (14%). Among 282 survivors, 89 (32%) had good, 112 (40%) mildly abnormal, 67 (24%) moderately abnormal, and 14 (5%) severely or very severely abnormal function at hospital discharge. Among neonates, development of renal failure and longer hospitalization were independently associated with worse Functional Status Scale. Chronic conditions, prematurity, venoarterial extracorporeal membrane oxygenation, increased red cell transfusion in the first 24 hours of extracorporeal membrane oxygenation, and longer extracorporeal membrane oxygenation duration were independently associated with mortality. Among pediatric patients, chronic neurologic conditions, tracheostomy or home ventilator, extracorporeal cardiopulmonary resuscitation, hepatic dysfunction, and longer ICU stay were independently associated with worse Functional Status Scale. Chronic cardiac conditions, hepatic dysfunction, and neurologic or thrombotic complications were independently associated with mortality. Achieving blood lactate concentration less than or equal to 2 mmol/L during extracorporeal membrane oxygenation was independently associated with survival in both neonatal and pediatric patients.
Conclusions:
In this study, about half of extracorporeal membrane oxygenation patients survived with good, mildly abnormal, or moderately abnormal function at hospital discharge. Patient and extracorporeal membrane oxygenation-related factors are associated with functional status and mortality.