Neurologic Outcomes in a Two-Center Cohort of Neonatal and Pediatric Patients Supported on Extracorporeal Membrane Oxygenation

Abstract

Contemporary studies of long-term outcomes in children supported on extracorporeal membrane oxygenation (ECMO) in the United States are limited. We enrolled 99 ECMO patients between July 2010 and June 2015 in a two-center prospective observational study that included neurologic and neuropsychologic evaluation at 6 and 12 months, using standardized outcome measures. Pre-ECMO, 20 (20%) had a pre-existing neurologic diagnosis, 40 (40%) had cardiac arrest, and 10 of 47 (21%) children with neuroimaging had acute abnormal findings. Of 50 children eligible for follow-up at 6 or 12 months, 40 (80%) returned for at least one visit. At the follow-up visit of longest interval from ECMO, the median Vineland Adaptive Behavior Scales-II (VABS-II) score was 91 (interquartile range [IQR], 81–98), the median Pediatric Stroke Outcome Measure (PSOM) score was 1 (IQR, 0–2), and the median Mullen Scales of Early Learning composite score was 85 (IQR, 72–96). Presence of new neuroimaging abnormalities during ECMO or within 6 weeks post-ECMO was associated with VABS-II score <85 or death within 12 months after ECMO. The Pediatric Cerebral Performance Category at hospital discharge showed a strong relationship with unfavorable VABS-II and PSOM scores at 6 or 12 months after ECMO. In this study, we report a higher prevalence of pre-ECMO neurologic conditions than previously described. In survivors to hospital discharge, median scores for adaptive behavior and cognitive, neurologic, and quality of life assessments were all below the general population means, but most deficits would be considered minor within each of the domains tested.

Cyclohexanone Exposure in Children on Extracorporeal Membrane Oxygenation Support

“…, one standard deviation below the reference population mean) or death up to 1 year after ECMO decannulation. 16…”

Cognitive and Psychological Outcomes Following Pediatric Cardiac Arrest

“…Broadly speaking, a child's adaptive behavior and functioning refer to the skills required to function well in one's environment and everyday life. Adaptive functioning in children who have suffered cardiac arrest has been assessed in studies using the Vineland Adaptive Behavior Scales-Second Edition (VABS-II; or the third edition, VABS-III) (20), a comprehensive parentreport measure that evaluates the domains of motor skills, communication, daily living, and socialization (21)(22)(23)(24)(25)(26)(27)(28)(29)(30). Many studies have found impairments in adaptive functioning (22,24,25,(27)(28)(29), motor functioning (22,24,(27)(28)(29), communication (22,(27)(28)(29), and daily living skills (22,24,(27)(28)(29), when assessed at various time points, including 3 and 12 months following cardiac arrest.…”

Neural Networks to Predict Radiographic Brain Injury in Pediatric Patients Treated with Extracorporeal Membrane Oxygenation

“…For children supported with ECMO who develop brain injury, survival is greatly reduced. Survivors with brain injury also have poor developmental and functional outcomes [ 4 , 5 , 6 , 7 , 8 ].…”