Extracorporeal Membrane Oxygenation Outcomes in Children With Preexisting Neurologic Disorders or Neurofunctional Disability

For the Pediatric ECMO (PediECMO) subgroup of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network and the Extracorporeal Life Support Organization (ELSO)

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Objective: Patient selection for pediatric extracorporeal membrane oxygenation (ECMO) support has broadened over the years to include children with pre-existing neurologic morbidities. We aimed to determine the prevalence and nature of pre-ECMO neurologic disorders or disability and investigate the association between pre-ECMO neurologic disorders or disability and mortality and unfavorable neurologic outcome. Design: Multicenter retrospective observational cohort study. Setting: Eight hospitals reporting to the Pediatric ECMO Outcomes Registry between October 2011 and June 2019. Patients: Children younger than 18 years supported with venoarterial or venovenous ECMO. Interventions: The primary exposure was presence of pre-ECMO neurologic disorders or moderate-to-severe disability, defined as Pediatric Cerebral Performance Category (PCPC) or Pediatric Overall Performance Category (POPC) 3-5. The primary outcome was unfavorable outcome at hospital discharge, defined as in-hospital mortality or survival with moderate-to-severe disability (discharge PCPC 3-5 with deterioration from baseline). Measurements and Main Results: Of 598 children included in the final cohort, 68 of 598 (11%) had a pre-ECMO neurologic disorder, 70 of 595 (12%) had a baseline PCPC 3-5, and 189 of 592 (32%) had a baseline POPC 3-5. The primary outcome of in-hospital mortality (n = 267) or survival with PCPC 3-5 with deterioration from baseline (n = 39) was observed in 306 of 598 (51%). Overall, one or more pre-ECMO neurologic disorders or disability were present in 226 of 598 children (38%) but, after adjustment for age, sex, diagnostic category, pre-ECMO cardiac arrest, and ECMO mode, were not independently associated with increased odds of unfavorable outcome (unadjusted odds ratio [OR], 1.34; 95% CI, 1.07-1.69; multivariable adjusted OR, 1.30; 95% CI, 0.92-1.82). Conclusions: In this exploratory study using a multicenter pediatric ECMO registry, more than one third of children requiring ECMO support had pre-ECMO neurologic disorders or disability. However, pre-existing morbidities were not independently associated with mortality or unfavorable neurologic outcomes at hospital discharge after adjustment for diagnostic category and other covariates.

Original languageEnglish (US)
Pages (from-to)881-892
Number of pages12
JournalPediatric Critical Care Medicine
Volume23
Issue number11
DOIs
StatePublished - Nov 1 2022

Bibliographical note

Funding Information:
Supported, in part, by the National Heart, Lung, and Blood Institute (T32 HL 125239; to Dr. Dante) and the National Institute of Neurological Disorders and Stroke of the National Institutes of Health under Award Number R01NS106292 (to Dr. Bembea).

Funding Information:
Dr. Dante’s institution received funding from the National Heart, Lung, and Blood Institute (T32 HL 125239). Drs. Dante, Ng, Patel, Steiner, and Bembea received support for article research from the National Institutes of Health (NIH). Drs. Ng’s and Patel’s institutions received funding from the NIH. Dr. Ng received funding from Ashvattha Therapeutics. Dr. Steiner received funding from Infant Jarvik Heart Data Safety Monitoring Board honorarium from HealthCore and Octapharma. Dr. Bembea’s institution received funding from the National Institute of Neurological Disorders and Stroke (R01NS106292) and a Grifols Investigator Sponsored Research Grant. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.

Keywords

  • child
  • extracorporeal membrane oxygenation
  • genetic diseases
  • nervous system diseases/epidemiology
  • neurodevelopmental
  • treatment

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