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Long-Term Neurobehavioral and Functional Outcomes of Pediatric Extracorporeal Membrane Oxygenation Survivors
Ashley D Turner1, Madison M Streb2, Amy Ouyang2
1From the Division of Pediatric Critical Care, Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri.
Insights
Pediatric extracorporeal membrane oxygenation (ECMO) survivors often experience mild neurobehavioral impairment in adaptive functioning long-term. However, many show improved functional status after hospital discharge.
Area of Science:
- Pediatric critical care medicine
- Neurodevelopmental outcomes
- Extracorporeal membrane oxygenation (ECMO) research
Background:
- Limited data exists on the long-term neurobehavioral outcomes for children who have undergone extracorporeal membrane oxygenation (ECMO).
- Understanding these outcomes is crucial for improving patient care and long-term prognosis.
Purpose of the Study:
- To characterize long-term neurobehavioral outcomes (≥1 year post-decannulation) in pediatric ECMO survivors.
- To identify risk factors associated with neurobehavioral impairment in this population.
- To evaluate the trajectory of functional status in pediatric ECMO survivors.
Main Methods:
- An observational study prospectively enrolled pediatric ECMO survivors (≥1 year post-decannulation, ≥3 years old at follow-up).
- Assessments included adaptive behavior (Vineland-3) and functional status (Functional Status Scale [FSS]).
- Patient characteristics were retrospectively collected.
Main Results:
- ECMO survivors (n=41) showed significantly lower scores than the normative population on the Vineland-3 Adaptive Behavior Composite (median 85) and all domains.
- Independent risk factors for lower scores included extracorporeal cardiopulmonary resuscitation, seizures during ECMO, congenital heart disease, and premorbid developmental delay.
- Of patients with impaired function at discharge (FSS ≥8), 86% showed improvement at follow-up.
Conclusions:
- Pediatric ECMO survivors typically exhibit mild, long-term neurobehavioral impairment in adaptive functioning.
- Continued functional recovery is probable after hospital discharge for these survivors.
Abstract:
There are limited reports of neurobehavioral outcomes of children supported on extracorporeal membrane oxygenation (ECMO). This observational study aims to characterize the long-term (≥1 year) neurobehavioral outcomes, identify risk factors associated with neurobehavioral impairment, and evaluate the trajectory of functional status in pediatric ECMO survivors. Pediatric ECMO survivors ≥1-year postdecannulation and ≥3 years of age at follow-up were prospectively enrolled and completed assessments of adaptive behavior (Vineland Adaptive Behavior Scales, Third Edition [Vineland-3]) and functional status (Functional Status Scale [FSS]). Patient characteristics were retrospectively collected. Forty-one ECMO survivors cannulated at 0.0-19.8 years (median: 2.4 [IQR: 0.0, 13.1]) were enrolled at 1.3-12.8 years (median: 5.5 [IQR: 3.3, 6.5]) postdecannulation. ECMO survivors scored significantly lower than the normative population in the Vineland-3 Adaptive Behavior Composite (85 [IQR: 70, 99], P < 0.001) and all domains (Communication, Daily Living, Socialization, Motor). Independent risk factors for lower Vineland-3 composite scores included extracorporeal cardiopulmonary resuscitation, electrographic seizures during ECMO, congenital heart disease, and premorbid developmental delay. Of the 21 patients with impaired function at discharge (FSS ≥8), 86% reported an improved FSS at follow-up. Pediatric ECMO survivors have, on average, mild neurobehavioral impairment related to adaptive functioning years after decannulation. Continued functional recovery after hospital discharge is likely.
