Two–year survival, mental, and motor outcomes after cardiac extracorporeal life support at less than five years of age

Lequier, Laurance; Joffe, Ari R.; Robertson, Charlene M.T.; Dinu, Irina; Wongswadiwat, Yuttapong; Anton, Natalie; Ross, David B.; Rebeyka, Ivan M.

doi:10.1016/j.jtcvs.2008.02.009

Cited by 86 publications

(79 citation statements)

References 25 publications

(38 reference statements)

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“…[1][2][3][4][5][6][7][8] The more recent era time cohort (2005)(2006)(2007)(2008)(2009)) demonstrated a significantly improved survival to hospital discharge (from 54% to 73%), similar to a recent report. 9 A shorter time for lactate to fall below 2 mmol/L on ECLS was significantly associated with improved survival to hospital discharge suggesting that aggressive ECLS support, often requiring additional venous access to achieve adequate flows, leads to better outcomes.…”

Section: Discussionsupporting

confidence: 74%

“…We have previously reported the 2-year survival and neurodevelopmental follow-up of the first cohort of patients (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)) in a separate publication. 4 ECLS was performed at Stollery Children's Hospital, Edmonton, Canada, for all patients.…”

Section: Methodsmentioning

confidence: 99%

“…4 Neurological morbidity post-ECLS varies widely depending on when and how the child is evaluated. 4,6,[9][10][11] This high incidence of adverse neurological outcomes has translated to increasing attention to neuroprotection during ECLS.…”

mentioning

confidence: 99%

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Survival and Neurocognitive Outcomes After Cardiac Extracorporeal Life Support in Children Less Than 5 Years of Age

Ryerson

Guerra

Joffe

et al. 2015

Circ: Heart Failure

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Background— Survival after pediatric cardiac extracorporeal life support (ECLS) is guarded, and neurological morbidity varies widely. Our objective is to report our 10-year experience with cardiac ECLS, including survival and kindergarten entry neurocognitive outcomes; to identify predictors of mortality or adverse neurocognitive outcomes; and to compare 2 eras, before and after 2005. Methods and Results— From 2000 to 2009, 98 children had venoarterial cardiac ECLS. Sixty-four patients (65%) survived to hospital discharge, and 50 (51%) survived ≤5 years of age. Neurocognitive follow-up of survivors was completed at mean (SD) age of 52.9 (8) months using Wechsler Preschool and Primary Scale of Intelligence. Logistic regression analysis found the longer time (hours) for lactate to fall below 2 mmol/L on ECLS (hazard ratio, 1.39; 95% confidence interval, 1.05, 1.84; P =0.022), and the amount of platelets (mL/kg) given in the first 48 hours (hazard ratio, 1.18; 95% confidence interval, 1.06, 1.32; P =0.002) was independently associated with higher in-hospital mortality. Receiving ECLS after the year 2005 was independently associated with lower risk of in-hospital mortality (hazard ratio, 0.36; 95% confidence interval, 0.13, 0.99; P =0.048). Extracorporeal cardiopulmonary resuscitation was not independently associated with mortality or neurocognitive outcomes. Era was not independently associated with neurocognitive outcomes. The full-scale intelligence quotient of survivors without chromosomal abnormalities was 79.7 (16.6) with 25% below 2 SD of the population mean. Conclusions— Mortality has improved over time; time for lactate to fall on ECLS and volume of platelets transfused are independent predictors of mortality. Extracorporeal cardiopulmonary resuscitation and era were not independently associated with neurocognitive outcomes.

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Section: Discussionsupporting

confidence: 74%

Section: Methodsmentioning

confidence: 99%

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Survival and Neurocognitive Outcomes After Cardiac Extracorporeal Life Support in Children Less Than 5 Years of Age

Ryerson

Guerra

Joffe

et al. 2015

Circ: Heart Failure

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“…With underlying cardiac disease, long-term survival when ECLS is initiated in a critical-care setting has been reported even after Ͼ50 minutes of standard CPR. 128,129,139,147 …”

Section: Extracorporeal Life Support (Ecls)mentioning

confidence: 99%

Part 14: Pediatric Advanced Life Support

Kleinman¹,

Chameides²,

Schexnayder³

et al. 2010

Circulation

907

304

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“…Survival for pediatric patients has been reported as anywhere from 23 to 73% based on published, single-center experiences [174][175][176][177][178][179][180][181][182]. Two multicenter registry database analyses have also been performed.…”

Section: Advances In Cerebral Resuscitation In Childrenmentioning

confidence: 99%

Pediatric Neurocritical Care

Murphy

2012

Neurotherapeutics

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Pediatric neurocritical care is an emerging multidisciplinary field of medicine and a new frontier in pediatric critical care and pediatric neurology. Central to pediatric neurocritical care is the goal of improving outcomes in critically ill pediatric patients with neurological illness or injury and limiting secondary brain injury through optimal critical care delivery and the support of brain function. There is a pressing need for evidence based guidelines in pediatric neurocritical care, notably in pediatric traumatic brain injury and pediatric stroke. These diseases have distinct clinical and pathophysiological features that distinguish them from their adult counterparts and prevent the direct translation of the adult experience to pediatric patients. Increased attention is also being paid to the broader application of neuromonitoring and neuroprotective strategies in the pediatric intensive care unit, in both primary neurological and primary non-neurological disease states. Although much can be learned from the adult experience, there are important differences in the critically ill pediatric population and in the circumstances that surround the emergence of neurocritical care in pediatrics.

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Two–year survival, mental, and motor outcomes after cardiac extracorporeal life support at less than five years of age

Abstract: Cardiac extracorporeal life support had a 41% 2-year survival. Potentially modifiable variables (time for lactate to normalize and highest inotrope score early during extracorporeal life support) explained 69% of mental score variance.

Cited by 86 publications

References 25 publications

Survival and Neurocognitive Outcomes After Cardiac Extracorporeal Life Support in Children Less Than 5 Years of Age

Survival and Neurocognitive Outcomes After Cardiac Extracorporeal Life Support in Children Less Than 5 Years of Age

Part 14: Pediatric Advanced Life Support

Pediatric Neurocritical Care

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