Hostname: page-component-8448b6f56d-dnltx Total loading time: 0 Render date: 2024-04-18T02:28:05.135Z Has data issue: false hasContentIssue false
  • English
  • Français

Intermediate-term outcomes after paediatric cardiac extracorporeal membrane oxygenation – what is known (and unknown)

Published online by Cambridge University Press:  13 December 2011

John M. Costello ,
David S. Cooper ,
Jeffrey P. Jacobs ,
Paul J. Chai ,
Roxanne Kirsch ,
Tami Rosenthal ,
Heidi J. Dalton ,
Joseph N. Graziano  and
James A. Quintessenza
John M. Costello*
Affiliation:
Children's Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
David S. Cooper
Affiliation:
The Congenital Heart Institute of Florida (CHIF), All Children's Hospital, Saint Petersburg, Florida, United States of America
Jeffrey P. Jacobs
Affiliation:
The Congenital Heart Institute of Florida (CHIF), All Children's Hospital, Saint Petersburg, Florida, United States of America
Paul J. Chai
Affiliation:
The Congenital Heart Institute of Florida (CHIF), All Children's Hospital, Saint Petersburg, Florida, United States of America
Roxanne Kirsch
Affiliation:
Children's Hospital of Philadelphia, University of PennsylvaniaSchool of Medicine, Philadelphia, Pennsylvania, United States of America
Tami Rosenthal
Affiliation:
Children's Hospital of Philadelphia, University of PennsylvaniaSchool of Medicine, Philadelphia, Pennsylvania, United States of America
Heidi J. Dalton
Affiliation:
Phoenix Children's Hospital, Phoenix, Arizona, United States of America
Joseph N. Graziano
Affiliation:
Phoenix Children's Hospital, Phoenix, Arizona, United States of America
James A. Quintessenza
Affiliation:
The Congenital Heart Institute of Florida (CHIF), All Children's Hospital, Saint Petersburg, Florida, United States of America
*
Correspondence to: Dr J. M. Costello, MD, MPH, Director, Regenstein Cardiac Care Unit, Division of Cardiology, Children's Memorial Hospital, 2300 Children's Plaza, Box 21, Chicago, Illinois 60614, United States of America. Tel: +1 773 880 3099; Fax: +1 773 880 8111; E-mail: jmcostello@childrensmemorial.org
Get access Rights & Permissions [Opens in a new window]

Abstract

The use of extracorporeal membrane oxygenation in infants and children with cardiac disease who develop refractory cardiogenic shock, cyanosis, or cardiac arrest is increasing. Early mortality in children with cardiac disease who require extracorporeal membrane oxygenation remains an important issue, as only 40% of cannulated patients survive to discharge from the hospital. However, it is encouraging that 90% children who are discharged alive from the hospital after extracorporeal membrane oxygenation are still alive at intermediate-term follow-up. Surviving patients are at risk for long-term dysfunction of multiple organ systems related to their underlying cardiac disease, non-cardiac comorbidities, treatment-related complications, and exposure to extracorporeal membrane oxygenation. Among the most important acute complications related to support with extracorporeal membrane oxygenation is injury to the central nervous system, which may contribute to adverse neurodevelopmental outcomes. All of these factors, in turn, influence quality of life. Many survivors remain medically complex related to their underlying cardiac disease, comorbidities, and sequelae of complications acquired over their lifetime. Neurological morbidity clearly plays an important role in approximately one-third of survivors, with significant deficits in approximately 10%. The limited data about quality of life data that are available for survivors of cardiac extracorporeal membrane oxygenation suggests that approximately 15–30% of survivors have at least moderately decreased quality of life. Overall, published data support the ongoing use of support with extracorporeal membrane oxygenation in children with acute cardiac failure, most of whom would die without it. However, programmatic efforts to improve the selection of patients and the preservation of the function of end organs during extracorporeal membrane oxygenation are clearly needed in order to improve long-term outcomes.

Keywords

Extracorporeal membrane oxygenationpaediatricscongenital cardiac defectquality of life
Type
Original Article
Information
Cardiology in the Young , Volume 21 , Issue S2: A Holistic Approach to Hypoplastic Left Heart Syndrome and other evolving challenges in Pediatric and Congenital Cardiac Disease , 13 December 2011 , pp. 118 - 123
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Haines, NM, Rycus, PT, Zwischenberger, JB, Bartlett, RH, Undar, A. Extracorporeal Life Support Registry Report 2008: neonatal and pediatric cardiac cases. ASAIO J 2009; 55: 111–116.CrossRefGoogle ScholarPubMed
2.Ibrahim, AE, Duncan, BW, Blume, ED, Jonas, RA. Long-term follow-up of pediatric cardiac patients requiring mechanical circulatory support. Ann Thorac Surg 2000; 69: 186–192.CrossRefGoogle ScholarPubMed
3.Hamrick, SEG, Gremmels, DB, Keet, CA, et al. Neurodevelopmental outcome of infants supported with extracorporeal membrane oxygenation after cardiac surgery. Pediatrics 2003; 111: e671–e675.CrossRefGoogle ScholarPubMed
4.Lequier, L, Joffe, AR, Robertson, CM, et al. Two-year survival, mental, and motor outcomes after cardiac extracorporeal life support at less than five years of age. J Thorac Cardiovasc Surg 2008; 136: 976–983, e3.CrossRefGoogle ScholarPubMed
5.Chow, G, Koirala, B, Armstrong, D, et al. Predictors of mortality and neurological morbidity in children undergoing extracorporeal life support for cardiac disease. Eur J Cardiothorac Surg 2004; 26: 38–43.CrossRefGoogle ScholarPubMed
6.Taylor, AK, Cousins, R, Butt, WW. The long-term outcome of children managed with extracorporeal life support: an institutional experience. Crit Care Resusc 2007; 9: 172–177.Google ScholarPubMed
7.McCrindle, BW, Williams, RV, Mitchell, PD, et al. Relationship of patient and medical characteristics to health status in children and adolescents after the Fontan procedure. Circulation 2006; 113: 1123–1129, Epub 2006 Feb 20.CrossRefGoogle ScholarPubMed
8.Kane, DA, Thiagarajan, RR, Wypij, D, et al. Rapid-response extracorporeal membrane oxygenation to support cardiopulmonary resuscitation in children with cardiac disease. Circulation. 2010; 122 (11 Suppl): S241–S248.CrossRefGoogle ScholarPubMed
9.Barrett, CS, Bratton, SL, Salvin, JW, Laussen, PC, Rycus, PT, Thiagarajan, RR. Neurological injury after extracorporeal membrane oxygenation use to aid pediatric cardiopulmonary resuscitation. Pediatr Crit Care Med 2009; 10: 445–451.CrossRefGoogle ScholarPubMed
10.Raymond, TT, Cunnyngham, CB, Thompson, MT, Thomas, JA, Dalton, HJ, Nadkarni, VM. Outcomes among neonates, infants, and children after extracorporeal cardiopulmonary resuscitation for refractory inhospital pediatric cardiac arrest: a report from the National Registry of Cardiopulmonary Resuscitation. Pediatr Crit Care Med 2010; 11: 362–371.Google ScholarPubMed
11.Van Litsenburg, R, De Mos, N, Edgell, D, Gruenwald, C, Bohn, DJ, Parshuram, CS. Resource use and health outcomes of paediatric extracorporeal membrane oxygenation. Arch Dis Child Fetal Neonatal Ed 2005; 90: F176–F177.CrossRefGoogle ScholarPubMed
12.Wagner, K, Risnes, I, Berntsen, T, et al. Clinical and psychosocial follow-up study of children treated with extracorporeal membrane oxygenation. Ann Thorac Surg 2007; 84: 1349–1355.CrossRefGoogle ScholarPubMed
13.Fligor, BJ, Neault, MW, Mullen, CH, Feldman, HA, Jones, DT. Factors associated with sensorineural hearing loss among survivors of extracorporeal membrane oxygenation therapy. Pediatrics 2005; 115: 1519–1528.CrossRefGoogle ScholarPubMed
14.Thiagarajan, RR, Laussen, PC, Rycus, PT, Bartlett, RH, Bratton, SL. Extracorporeal membrane oxygenation to aid cardiopulmonary resuscitation in infants and children. Circulation 2007; 116: 1693–1700.CrossRefGoogle ScholarPubMed
15.Meert, KL, Donaldson, A, Nadkarni, V, et al. Multicenter cohort study of in-hospital pediatric cardiac arrest. Pediatr Crit Care Med 2009; 10: 544–553.CrossRefGoogle ScholarPubMed
16.Limperopoulos, C, Tworetzky, W, McElhinney, DB, et al. Brain volume and metabolism in fetuses with congenital heart disease: evaluation with quantitative magnetic resonance imaging and spectroscopy. Circulation 2010; 121: 26–33.CrossRefGoogle ScholarPubMed
17.Licht, DJ, Shera, DM, Clancy, RR, et al. Brain maturation is delayed in infants with complex congenital heart defects. J Thorac Cardiovasc Surg 2009; 137: 529–536, discussion 36-7.CrossRefGoogle ScholarPubMed
18.Miller, SP, McQuillen, PS, Vigneron, DB, et al. Preoperative brain injury in newborns with transposition of the great arteries. Ann Thorac Surg 2004; 77: 1698–1706.CrossRefGoogle ScholarPubMed
19.Newburger, JW, Wypij, D, Bellinger, DC, et al. Length of stay after infant heart surgery is related to cognitive outcome at age 8 years. J Pediatr 2003; 143: 67–73.CrossRefGoogle ScholarPubMed
20.Marino, BS, Tomlinson, RS, Wernovsky, G, et al. Validation of the pediatric cardiac quality of life inventory. Pediatrics 2010; 126: 498–508.CrossRefGoogle ScholarPubMed
21.Mahle, WT, Forbess, JM, Kirshbom, PM, Cuadrado, AR, Simsic, JM, Kanter, KR. Cost-utility analysis of salvage cardiac extracorporeal membrane oxygenation in children. J Thorac Cardiovasc Surg 2005; 129: 1084–1090.CrossRefGoogle ScholarPubMed
22.Conlon, NP, Breatnach, C, O'Hare, BP, Mannion, DW, Lyons, BJ. Health-related quality of life after prolonged pediatric intensive care unit stay. Pediatr Crit Care Med 2009; 10: 41–44.CrossRefGoogle ScholarPubMed