Survival, Neurocognitive Outcome, and Quality of Life after Cardiac Extracorporeal membrane oxygenation in Children—A Single-Center Study

Objectives: Extracorporeal membrane oxygenation (ECMO) is increasingly applied in infants and children with cardiac disease, but knowledge about mortality and neurocognitive outcome is still limited. The objective of this study was to examine neurodevelopmental outcome and health-related quality of life (HRQoL) in school children who required cardiac ECMO after heart surgery in infancy/early childhood.

Methods: Between 2000 and 2013, 91 children (2.6% of all patients, median age 3 months) required ECMO after heart surgery. After successfully weaning, 13 patients died during hospital stay; 56 children (62%) were discharged home, respectively. Neurocognitive follow-up was performed in survivors between 5 and 16 years: 23 of 30 patients (77%) were re-examined. Median age at follow-up was 8 years and 3 months. Re-evaluation included a detailed neurological examination, assessment of the intelligence coefficient (IQ) by means of the culture fair test and assessment of selective attention. Parental questionnaire were used to measure HRQoL. Results were compared with those of 23 age- and sex-matched healthy comparison individuals.

Results: Median IQ was 97 in the study group (range: 45–124). IQ was poorer in patients after ECMO than in the comparison group (p < 0.001). Neurological examination revealed handicap in three patients; however, fine motoric assessment showed significant lower scores on all motor domains in 12 patients (52%). These results were significant poorer compared with the healthy comparison group (p < 0.001). In the attention test, the group after ECMO showed no significant difference. Quality of life was described as significant poorer to that of typically developing peers, only 35% described their quality of life as well to very well. However, the psychological burden on the parents did not differ between the study and the control groups.

Conclusion: ECMO is an important therapeutic issue in children with low cardiac output and survival is improving. Children after ECLS have higher risk for cognitive and motor impairments. Consequently, long-term neurodevelopmental follow-up are necessary to provide early educational and therapeutic support.

No conflict of interest has been declared by the author(s).