Clinical and psychosocial follow-up study of children treated with extracorporeal membrane oxygenation.
BACKGROUND
Serious heart and pulmonary failure may be treated with extracorporeal membrane oxygenation (ECMO). The aim of this follow-up study was a multimodal assessment of outcome in children surviving ECMO at our hospital from 1991 to 2004.


METHODS
Twenty-two children were, on average, 1.18 years old (SD = 1.92; range, 0.1 to 7.8) when ECMO was initiated. Average age at follow-up was 7.2 years (range, 1.8 to 13.9). Thirteen children were treated for cardiac and nine for pulmonary failure. Venoarterial ECMO was performed in 21 patients and venovenous ECMO in one patient. The protocol included a review of patients records, clinical, neurologic and neuropsychologic, and radiological examinations, electroencephalogram, and interviews with the parents.


RESULTS
Moderate or severe impairment in at least two clinical assessments were found in 16 (72.7%) children. Five (22.7%) children had cerebral palsy and 15 (68.2%) had moderate or severe cognitive impairment. Eight (36%) children had pathological radiologic findings. Pathological electroencephalograms were found in 11 (50%) patients including four (18.2%) with epileptic activity. Children with radiologic findings had a slightly worse cognitive outcome. There was no association between the neurophysiologic findings and the neuropsychologic performance or the radiologic findings. Based on parental assessment, only four children had pathological scores.


CONCLUSIONS
All children, except for two, came walking to the follow-up visit. All parents were positive to the ECMO treatment, and reported a good or slightly reduced quality of life for their child. Cerebral sequelae were frequently found in children treated with ECMO. The need for treatment and support should be assessed in order to optimize their physical and psychosocial functioning.
Wagner
Kari
K
Department of Anaesthesiology, Rikshospitalet-Radiumhospitalet Medical Centre, Oslo, Norway. kari.wagner@rikshospitalet.no
Risnes
Ivar
I
Berntsen
Torhild
T
Skarbø
Anne-Britt
AB
Ramberg
Brith
B
Vandvik
Inger Helene
IH
Rasmussen
Magnhild
M
Nome
Terje
T
Olsen
Ketil Berg
KB
Svennevig
Jan Ludvig
JL
D000222:Adaptation, Physiological; D000223:Adaptation, Psychological; D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002657:Child Development / Q000502:physiology; D002675:Child, Preschool; D015331:Cohort Studies; D016638:Critical Illness / Q000628:therapy*; D002658:Developmental Disabilities / Q000453:epidemiology* / Q000209:etiology*; D004569:Electroencephalography; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009483:Neuropsychological Tests; D011336:Probability; D018570:Risk Assessment; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D017741:Survivors; D013997:Time Factors