This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Hamrick, S. E. G.
Right arrow Articles by Piecuch, R. E.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Hamrick, S. E. G.
Right arrow Articles by Piecuch, R. E.
Related Collections
Right arrow Heart & Blood Vessels
PEDIATRICS Vol. 111 No. 6 June 2003, pp. e671-e675

ELECTRONIC ARTICLE

Neurodevelopmental Outcome of Infants Supported With Extracorporeal Membrane Oxygenation After Cardiac Surgery

Shannon E. G. Hamrick, MD, David B. Gremmels, MD, Corinne A. Keet, MS, Carol H. Leonard, PhD, J. Kelly Connell, RN, NNP, Samuel Hawgood, MB, BS and Robert E. Piecuch, MD

From the University of California San Francisco, San Francisco, California

Objectives. To evaluate the long-term neurodevelopmental outcome of infants who underwent cardiac surgery and required extracorporeal membrane oxygenation (ECMO) support, and to examine variables that predict death or disability in these patients.

Methods. We studied all infants who had congenital heart disease and were supported postoperatively with ECMO from 1990 to 2001 at our institution (n = 53). Medical records were reviewed retrospectively to obtain clinical variables. Neurologic and age-appropriate developmental examinations occurred at ages 1, 1.5, 2.5, and 4.5 years. Median age at follow-up was 55 months (9–101). Cognitive outcome was defined as suspect when scores were between 1 and 2 SD below the mean for age and abnormal when scores were >2 SD below mean for age. Neuromotor outcome was defined as suspect when the patient manifested clumsiness, tremor, or mild tone and reflex changes without functional limitations, and abnormal when there were functional limitations.

Results. In-hospital survival was 17 (32%) of 53. Of survivors, 14 (88%) of 16 are living and 1 patient was lost to follow-up. Of the 53 patients, 7 survived completely intact (13%). Seven (50%) of 14 patients had a normal cognitive outcome, 3 (21%) had a suspect cognitive outcome, and 4 (29%) were abnormal. Ten (72%) of 14 patients had a normal neuromotor outcome, 1 (7%) patient had a suspect neuromotor outcome, and 3 (21%) were abnormal. No survivor with an aortic cross-clamp time >40 minutes had a normal cognitive outcome. Nonsurvivors were more likely than survivors to have had cardiac arrest as an indication for ECMO (31% vs 6%), to have had a longer aortic cross-clamp time (mean 73 minutes vs 32 minutes), and to have required continuous arteriovenous hemofiltration (78% vs 35%). The age and weight at cannulation, gender, cardiac diagnosis, interval from surgery to ECMO, cardiopulmonary bypass time, diagnosis of sepsis or mediastinitis, and duration of ECMO were not significantly associated with survival.

Conclusions. Although mortality was 68% in infants who had congenital heart disease and were treated with ECMO postoperatively, of those who survive to hospital discharge, 75% have a normal neuromotor outcome and 50% have a normal cognitive outcome. These high rates of mortality and disability suggest that increased attention be paid to neuroprotection in these complex disorders.

Key Words: congenital heart disease • extracorporeal membrane oxygenation • neurodevelopmental outcome

Abbreviations: ECMO, extracorporeal membrane oxygenation • CHD, congenital heart disease • CPB, cardiopulmonary bypass • SD, standard deviation • CAVH, continuous arteriovenous hemofiltration • MRI, magnetic resonance imaging

Received for publication Nov 4, 2002; Accepted Feb 19, 2003.




This article has been cited by other articles:


Home page
 Eur. J. Cardiothorac. Surg.Home page
M. Tajik and M. G. Cardarelli
Extracorporeal membrane oxygenation after cardiac arrest in children: what do we know?
Eur. J. Cardiothorac. Surg., March 1, 2008; 33(3): 409 - 417.
[Abstract] [Full Text] [PDF]

Home page
 NeoReviewsHome page
M. A. Padula and A. M. Ades
Neurodevelopmental Implications of Congenital Heart Disease
NeoReviews, July 1, 2006; 7(7): e363 - e369.
[Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
A. Hoskote, D. Bohn, C. Gruenwald, D. Edgell, S. Cai, I. Adatia, and G. Van Arsdell
Extracorporeal life support after staged palliation of a functional single ventricle: Subsequent morbidity and survival
J. Thorac. Cardiovasc. Surg., May 1, 2006; 131(5): 1114 - 1121.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
W. T. Mahle, J. M. Forbess, P. M. Kirshbom, A. R. Cuadrado, J. M. Simsic, and K. R. Kanter
Cost-utility analysis of salvage cardiac extracorporeal membrane oxygenation in children
J. Thorac. Cardiovasc. Surg., May 1, 2005; 129(5): 1084 - 1090.
[Abstract] [Full Text] [PDF]

Home page
 AAP Grand RoundsHome page
S. L. Bratton
Neurodevelopmental Outcome After Cardiac Surgery Using ECLS
AAP Grand Rounds, October 1, 2003; 10(4): 49 - 49.
[Full Text] [PDF]