Predictors of mortality and neurological morbidity in children undergoing extracorporeal life support for cardiac disease.
OBJECTIVE
The objective of this study was to determine the incidence and risk factors for death and adverse neurological outcomes in children receiving extracorporeal life support (ECLS) for cardiac indications.


METHODS
A retrospective single centre consecutive cohort study was conducted in children who received ECLS for cardiac indications between January 1990 and June 2000. Health records and neuroimaging films were assessed, and long-term outcomes were obtained by standardized telephone follow-up or by assessments performed in outpatient clinic. Clinical, neuroimaging and surgical predictors of outcome were tested.


RESULTS
Of 90 children studied, short-term clinical neurological events (during hospitalization) occurred in 20 children (22%) during or following ECLS. Long-term neurological sequelae were present in 11 of 31 children discharged alive, after a mean follow-up interval of 4.5 years (range 4 months to 9 years). Death occurred in 59 children (66%) during hospitalisation, and in 3 following discharge. Of the 28 long-term survivors, only 15 children (17%) survived without neurological sequelae. Abnormal neuroimaging was associated with short-term neurological events (P = 0.03, OR 10.5), and the use of CPR prior to ECLS (P = 0.02, OR 2.9) was the only significant predictor of death. There were no significant predictors of long-term neurological sequelae.


CONCLUSIONS
More than two-thirds of the children receiving ECLS died, and 39% (11/28) of long-term survivors had neurological deficits. Although mortality is close to 100% without this type of support, there is still a significantly high morbidity and mortality with this type of support.
Chow
Gabriel
G
Division of Neurology, The Hospital for Sick Children, University of Toronto, Toronto, Ont., Canada. gcschow@hotmail.com
Koirala
Bhagawan
B
Armstrong
Derek
D
McCrindle
Brian
B
Bohn
Desmond
D
Edgell
David
D
Coles
John
J
de Veber
Gabrielle
G
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005112:Extracorporeal Circulation / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006330:Heart Defects, Congenital / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009422:Nervous System Diseases / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome