Long-term Neurobehavioral and Functional Outcomes of Pediatric Extracorporeal Membrane Oxygenation Survivors

Author:

Turner Ashley D.1,Streb Madison M.2,Ouyang Amy2,Leonard Skyler S.3,Hall Trevor A.3,Bosworth Christopher C.4,Williams Cydni N.5,Guerriero Réjean M.2,Hartman Mary E.1,Said Ahmed S.1,Guilliams Kristin P.126

Affiliation:

1. From the Division of Pediatric Critical Care, Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri

2. Division of Pediatric Neurology, Department of Neurology, Washington University in St. Louis, St. Louis, Missouri

3. Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon

4. Department of Psychology, St. Louis Children’s Hospital, St. Louis, Missouri

5. Division of Pediatric Critical Care, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon

6. Division of Neuroradiology, Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri.

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.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Reference33 articles.

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