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Published on: January 17, 2025
Long-Term Outcomes of Pediatric Cardiac Patients Supported by Extracorporeal Membrane Oxygenation
Matthew D Elias1, Barbara-Jo Achuff, Richard F Ittenbach
11Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA. 2Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA. 3Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital, Cincinnati, OH. 4Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA.
Insights
Long-term outcomes for pediatric cardiac patients on extracorporeal membrane oxygenation (ECMO) show 66% mortality. While many survivors report positive health and physical outcomes, children experience lower quality of life compared to healthy peers.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Extracorporeal membrane oxygenation (ECMO) is a vital short-term mechanical circulatory support for children with cardiac conditions.
- Limited data exists on the long-term health status and quality of life for these pediatric patients.
Purpose of the Study:
- To evaluate the long-term outcomes and quality of life in children who received ECMO for cardiac etiologies.
- To identify potential risk factors associated with long-term adverse outcomes.
Main Methods:
- Retrospective analysis of pediatric cardiac patients treated with ECMO from 1995-2012.
- Inclusion of patient- and parent-reported surveys for survivors to assess long-term outcomes.
- Univariate analyses to determine risk factors for mortality and morbidity.
Main Results:
- Over 18 years, 396 patients received ECMO, with a 43% survival rate to discharge.
- Median follow-up was 6 years, with an overall mortality of 66%.
- Among survivors, 18% experienced negative clinical outcomes; however, most reported positive health and physical status, while children reported lower quality of life scores compared to normative data.
Conclusions:
- Pediatric cardiac patients supported by ECMO face significant long-term mortality (66%).
- Survivors generally report favorable health and physical functioning, but younger children exhibit diminished quality of life.
- Further research is needed to improve long-term quality of life for pediatric ECMO survivors.
Objective:
Extracorporeal membrane oxygenation is an important form of short-term mechanical support in children with cardiac disease, but information on long-term outcomes and quality of life is limited. The primary objective of this study was to determine the long-term outcomes of children previously supported by extracorporeal membrane oxygenation for cardiac etiologies.
Design:
A retrospective analysis was performed on patients with cardiac disease managed with extracorporeal membrane oxygenation between January 1, 1995, and December 31, 2012, at the Children's Hospital of Philadelphia. Survivors completed patient- and parent-reported verbal and written surveys, and univariate analyses assessed risk factors for long-term outcomes.
Setting:
Tertiary-care children's hospital.
Patients:
Patients with cardiac disease managed with extracorporeal membrane oxygenation.
Interventions:
None.
Measurements And Main Results:
Over 18 years, 396 patients were managed with extracorporeal membrane oxygenation with 43% survival to discharge. The median age at cannulation was 78 days. The majority had congenital heart disease (86%), surgery prior to extracorporeal membrane oxygenation (71%), and cardiopulmonary arrest as the primary extracorporeal membrane oxygenation indication (53%). With 6-year median follow-up, 66% are known to be deceased, including 38 deaths after hospital discharge. Among survivors at discharge, 65 (38%) completed the phone survey, and 33 (19%) completed the written survey. Negative clinical outcomes, defined as having at least significant physical limitations or "fair" or "poor" health, were present in 18% of patients. No patient- or extracorporeal membrane oxygenation-related variables were associated with negative outcomes in univariate analyses. There were significantly lower self-reported and parent-reported written Pediatric Quality of Life Inventory quality of life scores in children compared with healthy individual normative data but no differences in adolescents.
Conclusions:
In this series of pediatric cardiac patients supported by extracorporeal membrane oxygenation, mortality was 66% with 6-year median follow-up. The majority reported positive outcomes with respect to health and physical limitations, but children reported lower quality of life compared with healthy individuals.
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