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Extracorporeal Membrane Oxygenation Outcomes in Children With Preexisting Neurologic Disorders or Neurofunctional
Siddhartha A Dante1, Megan K Carroll2, Derek K Ng2
1Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD.
Insights
Over a third of pediatric patients needing extracorporeal membrane oxygenation (ECMO) have pre-existing neurologic conditions. These pre-ECMO neurologic disorders did not independently increase mortality or unfavorable outcomes.
Area of Science:
- Pediatric critical care medicine
- Neurology
- Cardiovascular surgery
Background:
- Patient selection for pediatric extracorporeal membrane oxygenation (ECMO) has expanded to include children with pre-existing neurologic conditions.
- Understanding the impact of these neurologic morbidities is crucial for optimizing patient care.
Purpose of the Study:
- To determine the prevalence and nature of pre-ECMO neurologic disorders or disability in pediatric patients.
- To investigate the association between pre-ECMO neurologic disorders/disability and mortality or unfavorable neurologic outcomes.
Main Methods:
- A multicenter retrospective observational cohort study was conducted using data from the Pediatric ECMO Outcomes Registry (October 2011-June 2019).
- The study included children under 18 years supported with venoarterial or venovenous ECMO.
- Pre-ECMO neurologic disorders or moderate-to-severe disability (Pediatric Cerebral Performance Category/Pediatric Overall Performance Category 3-5) were assessed as the primary exposure.
Main Results:
- Of 598 children, 38% had pre-ECMO neurologic disorders or disability.
- The primary outcome (in-hospital mortality or survival with deterioration) occurred in 51% of patients.
- Pre-ECMO neurologic disorders or disability were not independently associated with increased odds of unfavorable outcomes after multivariable adjustment.
Conclusions:
- A significant proportion of pediatric ECMO patients present with pre-existing neurologic conditions.
- Despite the prevalence, these pre-existing neurologic morbidities were not found to be independent predictors of mortality or unfavorable neurologic outcomes at discharge.
Objective:
Patient selection for pediatric extracorporeal membrane oxygenation (ECMO) support has broadened over the years to include children with pre-existing neurologic morbidities. We aimed to determine the prevalence and nature of pre-ECMO neurologic disorders or disability and investigate the association between pre-ECMO neurologic disorders or disability and mortality and unfavorable neurologic outcome.
Design:
Multicenter retrospective observational cohort study.
Setting:
Eight hospitals reporting to the Pediatric ECMO Outcomes Registry between October 2011 and June 2019.
Patients:
Children younger than 18 years supported with venoarterial or venovenous ECMO.
Interventions:
The primary exposure was presence of pre-ECMO neurologic disorders or moderate-to-severe disability, defined as Pediatric Cerebral Performance Category (PCPC) or Pediatric Overall Performance Category (POPC) 3-5. The primary outcome was unfavorable outcome at hospital discharge, defined as in-hospital mortality or survival with moderate-to-severe disability (discharge PCPC 3-5 with deterioration from baseline).
Measurements And Main Results:
Of 598 children included in the final cohort, 68 of 598 (11%) had a pre-ECMO neurologic disorder, 70 of 595 (12%) had a baseline PCPC 3-5, and 189 of 592 (32%) had a baseline POPC 3-5. The primary outcome of in-hospital mortality ( n = 267) or survival with PCPC 3-5 with deterioration from baseline ( n = 39) was observed in 306 of 598 (51%). Overall, one or more pre-ECMO neurologic disorders or disability were present in 226 of 598 children (38%) but, after adjustment for age, sex, diagnostic category, pre-ECMO cardiac arrest, and ECMO mode, were not independently associated with increased odds of unfavorable outcome (unadjusted odds ratio [OR], 1.34; 95% CI, 1.07-1.69; multivariable adjusted OR, 1.30; 95% CI, 0.92-1.82).
Conclusions:
In this exploratory study using a multicenter pediatric ECMO registry, more than one third of children requiring ECMO support had pre-ECMO neurologic disorders or disability. However, pre-existing morbidities were not independently associated with mortality or unfavorable neurologic outcomes at hospital discharge after adjustment for diagnostic category and other covariates.
