Neurologic outcomes after extracorporeal membrane oxygenation: A systematic review

Katharine Boyle, Ryan Felling, Alvin Yiu, Wejdan Battarjee, Jamie Mc Elrath Schwartz, Cynthia Salorio, Melania M. Bembea

Research output: Contribution to journalArticlepeer-review

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 - 2018

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

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