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Updated: Jul 8, 2025
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Published on: January 17, 2025
Neurologic Outcomes and Quality of Life in Children After Extracorporeal Membrane Oxygenation
Alizée Michel1,2, Meryl Vedrenne-Cloquet1, Manoëlle Kossorotoff3
1Réanimation Medico-Chirurgicale Pédiatrique, Hôpital Necker Enfants Malades, Paris, France.
Insights
Extracorporeal membrane oxygenation (ECMO) survivors show reassuring long-term neurologic outcomes and quality of life. However, systematic follow-up is recommended due to the risk of neurodevelopmental impairment after ECMO support.
Area of Science:
- Pediatric critical care medicine
- Neurodevelopmental outcomes
- Quality of life research
Background:
- Extracorporeal membrane oxygenation (ECMO) is a life support method associated with potential brain injury in children.
- The long-term neurologic development and health-related quality of life (HRQoL) of pediatric ECMO survivors are not well understood.
Purpose of the Study:
- To describe the short- and long-term neurologic outcomes in pediatric survivors of ECMO.
- To evaluate the health-related quality of life (HRQoL) in these survivors.
Main Methods:
- Retrospective cohort study of 40 pediatric patients who underwent ECMO between October 2014 and January 2020.
- Neurologic assessments, including Pediatric Overall/Cerebral Performance Category (POPC/PCPC) scores, were performed at PICU discharge.
- Health-related quality of life (HRQoL) and neurodevelopmental status (Denver II test for younger children) were assessed at long-term follow-up.
Main Results:
- At PICU discharge, 38% of patients exhibited neurologic impairment.
- Long-term follow-up revealed reassuring health-related quality of life (HRQoL) scores, comparable to those with chronic diseases.
- Most survivors (36/40) had favorable Pediatric Overall/Cerebral Performance Category (POPC/PCPC) scores (≤3), and 7 of 15 younger children had normal Denver II test results.
Conclusions:
- Pediatric ECMO survivors generally do not present with severe long-term disability, and their health-related quality of life is reassuring.
- Given the identified risk of neurologic impairment, systematic follow-up for high-risk pediatric ECMO survivors is advisable.
Rationale:
Use of life support with extracorporeal membrane oxygenation (ECMO) is associated with brain injury. However, the consequences of these injuries on subsequent neurologic development and health-related quality of life (HRQoL) are poorly described in children.
Objectives:
The aim of this preliminary study was to describe short- and long-term neurologic outcomes in survivors of ECMO, as well as their HRQoL.
Design:
Retrospective identified cohort with contemporary evaluations.
Setting:
Necker Children's Hospital academic PICU.
Patients:
Forty survivors who underwent ECMO (October 2014 to January 2020) were included in follow-up assessments in May 2021.
Interventions:
None.
Measurement And Main Results:
We first reviewed the outcomes of ECMO at the time of PICU discharge, which included a summary of neurology, radiology, and Pediatric Overall/Cerebral Performance Category (POPC/PCPC) scores. Then, in May 2021, we interviewed parents and patients to assess HRQoL (Pediatric Quality of Life Inventory [PedsQL]) and POPC/PCPC for children 3 years old or older, and Denver II test (DTII) for younger children. An evaluation of DTII in the youngest patients 1 year after ECMO decannulation was also added. Median age at ECMO was 1.4 years (interquartile range [IQR], 0.4-6 yr). Thirty-five children (88%) underwent a venoarterial ECMO. At PICU discharge, 15 of 40 patients (38%) had neurologic impairment. Assessment of HRQoL was carried out at median of 1.6 years (IQR, 0.7-3.3 yr) after PICU discharge. PedsQL scores were over 70 of 100 for all patients (healthy peers mean results: 80/100), and scores were like those published in patients suffering with chronic diseases. In May 2021, seven of 15 patients had a normal DTII, and 36 of 40 patients had a POPC/PCPC score less than or equal to 3.
Conclusions:
None of our patients presented severe disability at long term, and HRQoL evaluation was reassuring. Considering the risk of neurologic impairment after ECMO support, a systematic follow-up of these high-risk survivor patients would be advisable.
