title: Neurodevelopmental Outcomes after Pediatric Cardiac ECMO Support.
abstract: OBJECTIVE
  To characterize the neurodevelopmental outcomes and identify factors associated with poor outcomes in pediatric patients undergoing cardiac extracorporeal membrane oxygenation (ECMO).
  
  
  METHODS
  Five year retrospective review, including demographics, cardiac lesion, and surgical complexity, reason for ECMO, ECMO complications, and neurodevelopmental status at discharge and latest follow-up. Neurodevelopmental status was determined through the Pediatric Overall Performance Category and Pediatric Cerebral Performance Category Scales.
  
  
  RESULTS
  Overall ECMO survival was 73% at hospital discharge and 66% a t the latest follow-up. Most patients underwent cardiopulmonary resuscitation (CPR) (43%), and the majority (53%) had a significant disease complexity (Aristotle = 4). Complications occurred in 42% of the ECMO runs, of which 12% were intracranial injuries. At hospital discharge, 75% of patients had normal to mild disability, improving to 81% at 2 years follow-up. At hospital discharge, moderate to severe disability was associated with CPR, plasma exchange or intracranial insults. After discharge, 23% showed improvement in neurologic status and 4% showed deterioration. Cerebral infarction was the only parameter associated with deterioration at the later follow-up stage.
  
  
  CONCLUSIONS
  Extracorporeal membrane oxygenation was successfully used in children with cardiac disease with 73 and 66% short and long-term survival respectively. Majority of the survivors had normal to mild neurodevelopmental disability and a significant portion showed neurologic improvement by the latest follow-up. Nevertheless, despite the grossly favorable outcomes standardized comprehensive neuropsychological testing is of paramount importance in all these patients.
authors.affiliation: Critical Care Medicine, Cardiac Intensive Care, Children's Hospital of Pittsburgh of UPMC , Pittsburgh, PA , USA.
authors.forename: Constantinos
authors.initials: C
authors.lastname: Chrysostomou
authors.affiliation: Cardiothoracic Surgery, Children's Hospital of Pittsburgh of UPMC , Pittsburgh, PA , USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Maul
authors.affiliation: Department of Anesthesiology, Children's Hospital of Pittsburgh of UPMC , Pittsburgh, PA , USA.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Callahan
authors.affiliation: Department of Anesthesiology, Children's Hospital of Pittsburgh of UPMC , Pittsburgh, PA , USA.
authors.forename: Khoa
authors.initials: K
authors.lastname: Nguyen
authors.affiliation: Department of Anesthesiology, Children's Hospital of Pittsburgh of UPMC , Pittsburgh, PA , USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Lichtenstein
authors.affiliation: Dietrich School of Arts and Sciences, University of Pittsburgh , Pittsburgh, PA , USA.
authors.forename: Emma G
authors.initials: EG
authors.lastname: Coate
authors.affiliation: Cardiothoracic Surgery, Children's Hospital of Pittsburgh of UPMC , Pittsburgh, PA , USA.
authors.forename: Victor O
authors.initials: VO
authors.lastname: Morell
authors.affiliation: Cardiothoracic Surgery, Children's Hospital of Pittsburgh of UPMC , Pittsburgh, PA , USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Wearden
keywords: E-CPR; ECMO; PCPC; cardiac arrest; cerebral infarction; children; intracranial hemorrhage; neurodevelopmental outcomes