Early Neurologic Complications and Long-term Neurologic Outcomes of Extracorporeal Membrane Oxygenation Performed in Children

Abstract

Background We aimed at evaluating acute neurologic complications (ANC) and clinical outcome at a 2-year follow-up in children after extracorporeal membrane oxygenation (ECMO).

Methods We conducted a single-center, retrospective review of our patient cohort aged between 1 month and 18 years at the time of ECMO support (between June 2014 to January 2017). Outcome analysis included ANC and their clinical consequences.The Pediatric Overall Performance Category (POPC) and Pediatric Cerebral Performance Category (PCPC) were used for neurologic assessment performed at discharge from the hospital and at 2nd year follow-up.

Results There were 35 children who required ECMO. The median ECMO time was 9 days (range 2–32 days). Decannulation from ECMO was achieved in 68.6% of patients, and overall, 42.8% survived (15 patients), The incidence of ANC in the surviving patients was 40% (6 children). ANC were intracranial hemorrhage, seizures, cerebral infarction, which occurred in one, two and three of the 15 surviving patients respectively (6.6, 13.3 and 20%). A higher rate of organ failure was related to death (p=0.043), whereas duration on ECMO was a risk factor for the development of ANC (p<0.05). At hospital discharge, the 14 patients evaluated had normal development or -mild disability in 73.2%, and at the 2-year follow-up, 93.4% had these scores.

Conclusion Children who receive ECMO have a risk to develop ANC, which was related to the length of ECMO treatment, while survival was related to less organ failure, Long-term neurological outcome was good in our patient cohort.

Zusammenfassung

Hintergrund In dieser Studie wollten wir akute neurologische Komplikationen (ANK) und ihre Folgen in einer 2-jährigen Beobachtung bei Kindern nach extrakorporaler Membranoxygenierung (ECMO) beschreiben und bewerten.

Methode Patienten in einem Alter zwischen 1 Monat und 18 Jahren, die zwischen Juni 2014 und Januar 2017 eine ECMO Unterstützung benötigten, wurden in diese Einzelzentrums- und retrospektive Studie aufgenommen. Die Ergebnisanalyse umfasste akute neurologische Komplikationen und ihre Folgen. Zur Bewertung wurden die ‚Pediatric Overall Performance Category‘ (POPC) und die ‚Pediatric Cerebral Performance Category‘ (PCPC) bei der Entlassung und bei der Nachuntersuchung im 2. Jahr verwendet.

Ergebnisse Es wurden 35 Kinder mit der ECMO behandelt. Die durchschnittliche Verweilzeit unter ECMO war neun Tage (2–32 Tage). Eine Beendigung der ECMO wurde bei 68,6%der Patienten erreicht und es überlebten insgesamt 43% (15 Kinder). Die Inzidenz von ANK bei den Überlebenden betrug 40% (6 Kinder): intrakranielle Blutung, zerebraler Anfall, Hirninfarkt, die bei einem, zwei, bzw drei der 15 überlebenden Kindern auftraten (6,6, 13,3 and 20%). Eine höhere Rate an Organversagen war mit dem Tod assoziiert (p=0,043), wohingegen die Zeit an der ECMO als Risikofaktor für die Entwicklung ANK identifiziert wurde (p<0,05). Score.Zum Zeitpunkt der Entlassung lag der score bei 73,2% der untersuchten 14 Patienten im normalen oder leicht beeinträchtigten Bereich; nach 2 Jahren zeigten 93,4% diese Scores

Schlußfolgerung Kinder, die ECMO-Therapie benötigen, haben, abhängig von der Dauer der Therapie, ein Risiko, ANK zu entwickeln. Das Überleben war mit geringer auftretendem Organversagen korreliert. Das neurologische Langzeitergebnis war in unserer Patientenkohorte gut.

Key words

Extracorporeal membrane oxygenation - acute neurologic complications - neurocognitive outcomes - children - pediatric intensive care

Schlüsselwörter

Extrakorporale Membranoxygenierung - akute neurologische Komplikationen - neurokognitive Ergebnisse - Kinder - pädiatrische Intensivstationpublished online 2022

Publikationsverlauf

Artikel online veröffentlicht:
21. Februar 2022

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