Neurologic outcomes after extracorporeal membrane oxygenation: A systematic review

Katharine Boyle, Ryan Felling, Alvin Yiu, Wejdan Battarjee, Jamie Schwartz, Cynthia F Salorio, Melania Bembea

Research output: Contribution to journalArticle

Abstract

Objectives: The goal of this systematic review of the literature was to summarize neurologic outcomes following neonatal and pediatric extracorporeal membrane oxygenation. Data Sources: We conducted electronic searches of PubMed, Scopus, Web of Science, CINAHL, Cochrane, and EMBASE. Study Selection: Inclusion criteria included publication dates 2000-2016, patient ages 0-18 years, and use of standardized measures to evaluate outcomes after extracorporeal membrane oxygenation. Data Extraction: We identified 3,497 unique citations; 60 full-Text articles were included in the final review. Data Synthesis: Studies evaluated patients with congenital diaphragmatic hernia (7), cardiac disease (8), cardiac arrest (13), and mixed populations (32). Follow-up was conducted at hospital discharge in 10 studies (17%) and at a median of 26 months (interquartile range, 8-61 mo) after extracorporeal membrane oxygenation in 50 studies (83%). We found 55 outcome measures that assessed overall health and function (4), global cognitive ability (7), development (4), motor function (5), adaptive function (2), behavior/mood (6), hearing (2), quality of life (2), school achievement (5), speech and language (6), learning and memory (4), and attention and executive function (8). Overall, 10% to as many as 50% of children scored more than 2 sds below the population mean on cognitive testing. Behavior problems were identified in 16-46% of children tested, and severe motor impairment was reported in 12% of children. Quality of life of former extracorporeal membrane oxygenation patients evaluated at school age or adolescence ranged from similar to healthy peers, to 31-53% having scores more than 1 sd below the population mean. Conclusions: This systematic review of the literature suggests that children who have undergone extracorporeal membrane oxygenation suffer from a wide range of disabilities. A meta-Analysis was not feasible due to heterogeneity in pathologies, outcome measures, and age at follow-up, underscoring the importance of developing and employing a core set of outcomes measures in future extracorporeal membrane oxygenation studies. (Pediatr Crit Care Med 2018; 19:760-766).

Original languageEnglish (US)
Pages (from-to)760-766
Number of pages7
JournalPediatric Critical Care Medicine
Volume19
Issue number8
DOIs
StatePublished - Jan 1 2018

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Extracorporeal Membrane Oxygenation
Nervous System
Outcome Assessment (Health Care)
Quality of Life
Population
Aptitude
Information Storage and Retrieval
Executive Function
Heart Arrest
PubMed
Patient Selection
Hearing
Publications
Meta-Analysis
Heart Diseases
Language
Learning
Pediatrics
Pathology
Health

Keywords

  • Extracorporeal membrane oxygenation; intensive care unit
  • Neurocognitive outcomes
  • Neurodevelopmental outcomes
  • Pediatric intensive care unit
  • Pediatrics

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine

Cite this

Neurologic outcomes after extracorporeal membrane oxygenation : A systematic review. / Boyle, Katharine; Felling, Ryan; Yiu, Alvin; Battarjee, Wejdan; Schwartz, Jamie; Salorio, Cynthia F; Bembea, Melania.

In: Pediatric Critical Care Medicine, Vol. 19, No. 8, 01.01.2018, p. 760-766.

Research output: Contribution to journalArticle

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abstract = "Objectives: The goal of this systematic review of the literature was to summarize neurologic outcomes following neonatal and pediatric extracorporeal membrane oxygenation. Data Sources: We conducted electronic searches of PubMed, Scopus, Web of Science, CINAHL, Cochrane, and EMBASE. Study Selection: Inclusion criteria included publication dates 2000-2016, patient ages 0-18 years, and use of standardized measures to evaluate outcomes after extracorporeal membrane oxygenation. Data Extraction: We identified 3,497 unique citations; 60 full-Text articles were included in the final review. Data Synthesis: Studies evaluated patients with congenital diaphragmatic hernia (7), cardiac disease (8), cardiac arrest (13), and mixed populations (32). Follow-up was conducted at hospital discharge in 10 studies (17{\%}) and at a median of 26 months (interquartile range, 8-61 mo) after extracorporeal membrane oxygenation in 50 studies (83{\%}). We found 55 outcome measures that assessed overall health and function (4), global cognitive ability (7), development (4), motor function (5), adaptive function (2), behavior/mood (6), hearing (2), quality of life (2), school achievement (5), speech and language (6), learning and memory (4), and attention and executive function (8). Overall, 10{\%} to as many as 50{\%} of children scored more than 2 sds below the population mean on cognitive testing. Behavior problems were identified in 16-46{\%} of children tested, and severe motor impairment was reported in 12{\%} of children. Quality of life of former extracorporeal membrane oxygenation patients evaluated at school age or adolescence ranged from similar to healthy peers, to 31-53{\%} having scores more than 1 sd below the population mean. Conclusions: This systematic review of the literature suggests that children who have undergone extracorporeal membrane oxygenation suffer from a wide range of disabilities. A meta-Analysis was not feasible due to heterogeneity in pathologies, outcome measures, and age at follow-up, underscoring the importance of developing and employing a core set of outcomes measures in future extracorporeal membrane oxygenation studies. (Pediatr Crit Care Med 2018; 19:760-766).",
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AU - Boyle, Katharine

AU - Felling, Ryan

AU - Yiu, Alvin

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AU - Schwartz, Jamie

AU - Salorio, Cynthia F

AU - Bembea, Melania

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AB - Objectives: The goal of this systematic review of the literature was to summarize neurologic outcomes following neonatal and pediatric extracorporeal membrane oxygenation. Data Sources: We conducted electronic searches of PubMed, Scopus, Web of Science, CINAHL, Cochrane, and EMBASE. Study Selection: Inclusion criteria included publication dates 2000-2016, patient ages 0-18 years, and use of standardized measures to evaluate outcomes after extracorporeal membrane oxygenation. Data Extraction: We identified 3,497 unique citations; 60 full-Text articles were included in the final review. Data Synthesis: Studies evaluated patients with congenital diaphragmatic hernia (7), cardiac disease (8), cardiac arrest (13), and mixed populations (32). Follow-up was conducted at hospital discharge in 10 studies (17%) and at a median of 26 months (interquartile range, 8-61 mo) after extracorporeal membrane oxygenation in 50 studies (83%). We found 55 outcome measures that assessed overall health and function (4), global cognitive ability (7), development (4), motor function (5), adaptive function (2), behavior/mood (6), hearing (2), quality of life (2), school achievement (5), speech and language (6), learning and memory (4), and attention and executive function (8). Overall, 10% to as many as 50% of children scored more than 2 sds below the population mean on cognitive testing. Behavior problems were identified in 16-46% of children tested, and severe motor impairment was reported in 12% of children. Quality of life of former extracorporeal membrane oxygenation patients evaluated at school age or adolescence ranged from similar to healthy peers, to 31-53% having scores more than 1 sd below the population mean. Conclusions: This systematic review of the literature suggests that children who have undergone extracorporeal membrane oxygenation suffer from a wide range of disabilities. A meta-Analysis was not feasible due to heterogeneity in pathologies, outcome measures, and age at follow-up, underscoring the importance of developing and employing a core set of outcomes measures in future extracorporeal membrane oxygenation studies. (Pediatr Crit Care Med 2018; 19:760-766).

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