Survival and neurocognitive outcomes in pediatric extracorporeal-cardiopulmonary resuscitation

Guerra, Gonzalo Garcia; Zorzela, Liliane; Robertson, Charlene M.T.; Alton, Gwen Y.; Joffe, Ari R.; Moez, Elham Khodayari; Dinu, Irina; Ross, David B.; Rebeyka, Ivan M.; Lequier, Laurance

doi:10.1016/j.resuscitation.2015.07.034

Cited by 46 publications

(33 citation statements)

References 36 publications

(34 reference statements)

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“…Of interest, survival improved in the more recent era, and this was associated with lower lactate and inotrope scores prior to ECMO cannulation [18]. In 51 cardiac patients having E-CPR, the CPTFP reported 49% survival to hospital discharge, 43% survival to 5 years, full-scale intelligence quotient of survivors 76.5 (SD 15.9), GAC of 74.5 (SD 20.3) with 47% having a score below 2 SD of the population mean, and 24% having both full-scale intelligence quotient and GAC below 2 SD of the population mean, similar findings to those of all cardiac ECMO cases in the 10-year review [19]. When the CPTFP examined health-related quality of life, this was lower in cardiac ECMO survivors than in other children with CHD having surgery in early infancy; whether cannulation was from the operating room or done in the PCICU was not associated with this outcome [20].…”

Section: Discussionsupporting

confidence: 66%

Predictors and outcomes of early post-operative veno-arterial extracorporeal membrane oxygenation following infant cardiac surgery

et al. 2018

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BackgroundWe aimed to determine predictors of, and outcomes after, veno-arterial extracorporeal membrane oxygenation instituted within 48 h after cardiac surgery (early ECMO) in young infants.MethodsPatients ≤ 6 weeks old having cardiac surgery from 2003 to 2012 were enrolled prospectively. Patients cannulated pre-operatively, intra-operatively, or ≥ 48 h post-operatively were excluded. Variables at p ≤ 0.1 on univariate regression were entered into multiple logistic regression to predict early ECMO. Early-ECMO cases were matched 1:2 for six demographic variables, and death by age 2 years old (determined using conditional logistic regression; presented as odds ratio (OR), 95% confidence interval (CI)) and General Adaptive Composite scores at age 2 years (determined using Wilcoxon rank sum) were compared; p ≤ 0.05 was considered statistically significant.ResultsOf 565 eligible patients over the 10-year period, 20 had early ECMO instituted at a mean (standard deviation) of 12.4 (11.4) h post-operatively, 10 of whom had extracorporeal cardiopulmonary resuscitation. Of early-ECMO patients, 8 (40%) were found to have residual anatomic defects requiring intervention with catheterization (n = 1) and/or surgery (n = 7). On multiple regression, the post-operative day 1 highest vasoactive-inotrope score (OR 1.02; 95%CI 1.06,1.08; p < 0.001), highest lactate (OR 1.2; 95%CI 1.06,1.35; p = 0.003), and lowest base deficit (OR 0.82; 95%CI 0.71,0.94; p = 0.004), CPB time (OR 1.01; 95%CI 1.00,1.02; p = 0.002), and single-ventricle anatomy (OR 5.35; 95%CI 1.66,17.31; p = 0.005) were associated with early ECMO. Outcomes at 2 years old compared between early-ECMO and matched patients were mortality 11/20 (55%) vs 11/40 (28%) (OR 3.22, 95%CI 0.98,10.63; p = 0.054) and General Adaptive Composite median 65 [interquartile range (IQR) 58, 81.5] in 9 survivors vs 93 [IQR 86.5, 102.5] in 29 survivors (p = 0.02).ConclusionsThe identified risk factors for, and outcomes after, having early ECMO may aid decision making in the acute period and confirm that neurodevelopmental follow-up for these children is necessary. The hypothesis that earlier institution of ECMO may improve long-term outcomes requires further study.

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Section: Discussionsupporting

confidence: 66%

Predictors and outcomes of early post-operative veno-arterial extracorporeal membrane oxygenation following infant cardiac surgery

et al. 2018

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“…Overall, our study shows a hospital survival to ECPR of 65.5% and a 3-year follow-up survival of 62.1%, numbers that are relatively higher than those reported in previous ECPR studies and the latest ELSO Registry (6, 12–13). The most recent ELSO registry data reveals that in last decade the use of pediatric ECPR has increased tenfold, however hospital survival rates have remained consistent, from 39% in 2004 to 41% in 2016 (6).…”

Section: Discussioncontrasting

confidence: 63%

“…In the early 1990’s extracorporeal membrane oxygenation (ECMO) support instituted as rescue therapy during CPR promoted survival in children with cardiac disease who had cardiopulmonary arrest and failed to respond to conventional CPR (3). Since then, ECPR has been increasingly used as a method to improve survival in patients with refractory CA due to cardiac and non-cardiac etiology (4,5). An ELSO registry report which reviewed data from 2004 to 2016 showed an important increase of pediatric ECPR, but did not demonstrate improved survival (6).…”

Section: Introductionmentioning

confidence: 99%

Survival and Long-Term Functional Outcomes for Children With Cardiac Arrest Treated With Extracorporeal Cardiopulmonary Resuscitation

Torres-Andres¹,

Fink

Bell

et al. 2018

Pediatric Critical Care Medicine

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“…The same group reported on neurodevelopmental outcomes in a subset of 17 five-year-old ECPR survivors with cardiac disease who were assessed at least 6 months after ECPR. This subset had a mean IQ of 76.5, and 24% had an IQ below−2 SD ( 93 ). Wagner and coworkers evaluated 14 children who underwent ECMO (10 for cardiac disease and 4 for respiratory failure) after the first month of life at a mean age of 7.2 years.…”

Section: Long-term Outcomesmentioning

confidence: 99%

Improving Long-Term Outcomes After Extracorporeal Membrane Oxygenation: From Observational Follow-Up Programs Toward Risk Stratification

et al. 2018

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Since the introduction of extracorporeal membrane oxygenation (ECMO), more neonates and children with cardiorespiratory failure survive. Interest has therefore shifted from reduction of mortality toward evaluation of long-term outcomes and prevention of morbidity. This review addresses the changes in ECMO population and the ECMO-treatment that may affect long-term outcomes, the diagnostic modalities to evaluate neurological morbidities and their contributions to prognostication of long-term outcomes. Most follow-up data have only become available from observational follow-up programs in neonatal ECMO-survivors. The main topics are discussed in this review. Recommendations for long-term follow up depend on the presence of neurological comorbidity, the nature and extent of the underlying disease, and the indication for ECMO. Follow up should preferably be offered as standard of care, and in an interdisciplinary, structured and standardized way. This permits evaluation of outcome data and effect of interventions. We propose a standardized approach and recommend that multiple domains should be evaluated during long-term follow up of neonates and children who needed extracorporeal life support.

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Survival and neurocognitive outcomes in pediatric extracorporeal-cardiopulmonary resuscitation

Cited by 46 publications

References 36 publications

Predictors and outcomes of early post-operative veno-arterial extracorporeal membrane oxygenation following infant cardiac surgery

Predictors and outcomes of early post-operative veno-arterial extracorporeal membrane oxygenation following infant cardiac surgery

Survival and Long-Term Functional Outcomes for Children With Cardiac Arrest Treated With Extracorporeal Cardiopulmonary Resuscitation

Improving Long-Term Outcomes After Extracorporeal Membrane Oxygenation: From Observational Follow-Up Programs Toward Risk Stratification

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