Skip to main content

Advertisement

SpringerLink
Log in

Early Neurodevelopmental Outcomes in Children Supported with ECMO for Cardiac Indications

  • Original Article
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

Extracorporeal membrane oxygenation (ECMO) is lifesaving for many critically ill children with congenital heart disease (CHD). However, limited information is available about their ensuing neurodevelopmental (ND) outcomes. We describe early ND outcomes in a cohort of children supported with ECMO for cardiac indications. Twenty-eight patients supported with ECMO at age < 36 months underwent later ND testing at 12–42 months of age using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III). ND scores were compared with normative means and with ND outcomes of a matched cohort of 79 children with CHD undergoing cardiac surgery but not requiring ECMO support. Risk factors for worse ND outcomes were identified using multivariable linear regression models. Cardiac ECMO patients had ND scores at least one standard deviation below the normative mean in the gross motor (61%), language (43%), and cognitive (29%) domains of the Bayley-III. Cardiac ECMO patients had lower scores on the motor, language, and cognitive domains as compared to the matched non-ECMO group and clinically important (1/2 SD) differences in the motor domain persisted after controlling for primary caregiver education and number of cardiac catheterizations. Risk factors of worse ND outcomes among cardiac ECMO patients in more than one developmental domain included older age at first cannulation and more cardiac catheterization and cardiac surgical procedures prior to ND assessment. Overall, children supported on ECMO for cardiac indications have significant developmental delays and warrant close ND follow-up.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Crow S, Fischer AC, Schears RM (2009) Extracorporeal life support: utilization, cost, controversy, and ethics of trying to save lives. Semin Cardiothorac Vasc Anesth 13(3):183–191

    Article  PubMed  Google Scholar 

  2. Duncan BW, Bohn DJ, Atz AM, French JW, Laussen PC, Wessel DL (2001) Mechanical circulatory support for the treatment of children with acute fulminant myocarditis. J Thorac Cardiovasc Surg 122(3):440–448

    Article  CAS  PubMed  Google Scholar 

  3. Ghelani SJ, Spaeder MC, Pastor W, Spurney CF, Klugman D (2012) Demographics, trends, and outcomes in pediatric acute myocarditis in the United States, 2006 to 2011. Circ Cardiovasc Qual Outcomes 5(5):622–627

    Article  PubMed  Google Scholar 

  4. Kane DA, Thiagarajan RR, Wypij D, Scheurer MA, Fynn-Thompson F, Emani S, Pedro J, Betit P, Laussen PC (2010) Rapid-response extracorporeal membrane oxygenation to support cardiopulmonary resuscitation in children with cardiac disease. Circulation 122(11 suppl 1):S241–S248

    Article  CAS  PubMed  Google Scholar 

  5. Thiagarajan RR, Laussen PC, Rycus PT, Bartlett RH, Bratton SL (2007) Extracorporeal membrane oxygenation to aid cardiopulmonary resuscitation in infants and children. Circulation 116(15):1693–1700

    Article  PubMed  Google Scholar 

  6. Salvin JW, Laussen PC, Thiagarajan RR (2008) Extracorporeal membrane oxygenation for postcardiotomy mechanical cardiovascular support in children with congenital heart disease. Pediatr Anesth 18(12):1157–1162

    Google Scholar 

  7. Mascio CE, Austin EH, Jacobs JP, Jacobs ML, Wallace AS, He X, Pasquali SK (2014) Perioperative mechanical circulatory support in children: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. J Thorac Cardiovasc Surg 147(2):658–665

    Article  PubMed  Google Scholar 

  8. Paden ML, Rycus PT, Thiagarajan RR (2014) Update and outcomes in extracorporeal life support. Semin Perinatol 38(2):65–70

    Article  PubMed  Google Scholar 

  9. Fligor BJ, Neault MW, Mullen CH, Feldman HA, Jones DT (2005) Factors associated with sensorineural hearing loss among survivors of extracorporeal membrane oxygenation therapy. Pediatrics 115(6):1519–1528

    Article  PubMed  Google Scholar 

  10. Zwiers AJ, de Wildt SN, Hop WC, Dorresteijn EM, Gischler SJ, Tibboel D, Cransberg K (2013) Acute kidney injury is a frequent complication in critically ill neonates receiving extracorporeal membrane oxygenation: a 14-year cohort study. Crit Care 17(4):R151

    Article  PubMed  PubMed Central  Google Scholar 

  11. Polito A, Barrett CS, Wypij D, Rycus PT, Netto R, Cogo PE, Thiagarajan RR (2013) Neurologic complications in neonates supported with extracorporeal membrane oxygenation. An analysis of ELSO registry data. Intensive Care Med 39(9):1594–1601

    Article  CAS  PubMed  Google Scholar 

  12. Mehta A, Ibsen LM (2013) Neurologic complications and neurodevelopmental outcome with extracorporeal life support. World J Crit Care Med 2(4):40

    Article  PubMed  PubMed Central  Google Scholar 

  13. Chrysostomou C, Maul T, Morell VO, Callahan PM, Nguyen K, Lichtenstein S, Coate EG, Wearden P (2013) Neurodevelopmental outcomes after pediatric cardiac ECMO support. Front Pediatr 1:47

    Article  PubMed  PubMed Central  Google Scholar 

  14. Ravishankar C, Dominguez TE, Kreutzer J, Wernovsky G, Marino BS, Godinez R, Priestley MA, Gruber PJ, Gaynor WJ, Nicolson SC (2006) Extracorporeal membrane oxygenation after stage I reconstruction for hypoplastic left heart syndrome. Pediatr Crit Care Med 7(4):319–323

    Article  PubMed  Google Scholar 

  15. Brown KL, Ichord R, Marino BS, Thiagarajan RR (2013) Outcomes following extracorporeal membrane oxygenation in children with cardiac disease. Pediatr Crit Care Med 14(5_suppl):S73–S83

    Article  PubMed  Google Scholar 

  16. Thiagarajan RR (2016) Extracorporeal membrane oxygenation for cardiac indications in children. Pediatr Crit Care Med 17(8_suppl):S155–S159

    Article  PubMed  Google Scholar 

  17. Costello JM, Cooper DS, Jacobs JP, Chai PJ, Kirsch R, Rosenthal T, Dalton HJ, Graziano JN, Quintessenza JA (2011) Intermediate-term outcomes after paediatric cardiac extracorporeal membrane oxygenation–what is known (and unknown). Cardiol Young 21(Suppl 2):118–123

    Article  PubMed  Google Scholar 

  18. Ibrahim AE, Duncan BW, Blume ED, Jonas RA (2000) Long-term follow-up of pediatric cardiac patients requiring mechanical circulatory support. Ann Thorac Surg 69(1):186–192

    Article  CAS  PubMed  Google Scholar 

  19. Hamrick SE, Gremmels DB, Keet CA, Leonard CH, Connell JK, Hawgood S, Piecuch RE (2003) Neurodevelopmental outcome of infants supported with extracorporeal membrane oxygenation after cardiac surgery. Pediatrics 111(6):e671–e675

    Article  PubMed  Google Scholar 

  20. Chow G, Koirala B, Armstrong D, McCrindle B, Bohn D, Edgell D, Coles J, de Veber G (2004) Predictors of mortality and neurological morbidity in children undergoing extracorporeal life support for cardiac disease. Eur J Cardiothorac Surg 26(1):38–43

    Article  PubMed  Google Scholar 

  21. Lequier L, Joffe AR, Robertson CM, Dinu IA, Wongswadiwat Y, Anton NR, Ross DB, Rebeyka IM (2008) Two–year survival, mental, and motor outcomes after cardiac extracorporeal life support at less than five years of age. J Thorac Cardiovasc Surg 136 (4):976–983. e973

  22. Huang SC, Wu ET, Chen YS, Chang CI, Chiu S, Wang SS, Lin FY, Ko WJ (2008) Extracorporeal membrane oxygenation rescue for cardiopulmonary resuscitation in pediatric patients. Crit Care Med 36(5):1607–1613

    Article  PubMed  Google Scholar 

  23. Bayley N (2006) Bayley scales of infant and toddler development, third edition, 3rd edn. Harcourt Assessment Inc., San Antonio

    Google Scholar 

  24. Bzoch KR, League R, Brown VL (2003) Receptive-expressive emergent language test, third edition (REEL-3). Pearson, San Antonio

    Google Scholar 

  25. Carter AS, Briggs-Gowan MJ (2006) ITSEA: infant-Toddler social and emotional assessment. PsychCorp, San Antonio

    Google Scholar 

  26. Reynolds CR (2004) Behavior assessment system for children, 2nd edn. Pearson, Minneapolis

    Google Scholar 

  27. Johnson S, Moore T, Marlow N (2014) Using the Bayley-III to assess neurodevelopmental delay: which cut-off should be used? Pediatr Res 75(5):670–674

    Article  PubMed  Google Scholar 

  28. Ballweg JA, Wernovsky G, Gaynor JW (2007) Neurodevelopmental outcomes following congenital heart surgery. Pediatr Cardiol 28(2):126–133

    Article  PubMed  Google Scholar 

  29. Gaynor JW, Wernovsky G, Jarvik GP, Bernbaum J, Gerdes M, Zackai E, Nord AS, Clancy RR, Nicolson SC, Spray TL (2007) Patient characteristics are important determinants of neurodevelopmental outcome at one year of age after neonatal and infant cardiac surgery. J Thorac Cardiovas Surg 133(5):1344–1353. e1343

  30. Brown KL, Utens E, Marino BS (2018) The ten things you need to know about long-term outcomes following paediatric cardiac surgery. Intensive Care Med 44(9):918–921

    Article  PubMed  Google Scholar 

  31. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42(2):377–381

    Article  PubMed  Google Scholar 

  32. IJsselstijn H, van Heijst AF (2014) Long-term outcome of children treated with neonatal extracorporeal membrane oxygenation: increasing problems with increasing age. Semin Perinatol 38(2):114–121

    Article  PubMed  Google Scholar 

  33. Costello JM, O’Brien M, Wypij D, Shubert J, Salvin JW, Newburger JW, Laussen PC, Arnold JH, Fynn-Thompson F, Thiagarajan RR (2012) Quality of life of pediatric cardiac patients who previously required extracorporeal membrane oxygenation. Pediatr Crit Care Med 13(4):428–434

    Article  PubMed  Google Scholar 

  34. Shellhaas RA, Chang T, Tsuchida T, Scher MS, Riviello JJ, Abend NS, Nguyen S, Wusthoff CJ, Clancy RR (2011) The American Clinical Neurophysiology Society's guideline on continuous electroencephalography monitoring in neonates. J Clin Neurophysiol 28(6):611–617

    Article  PubMed  Google Scholar 

  35. Marino BS, Lipkin PH, Newburger JW, Peacock G, Gerdes M, Gaynor JW, Mussatto KA, Uzark K, Goldberg CS, Johnson WH Jr, Li J, Smith SE, Bellinger DC, Mahle WT (2012) Neurodevelopmental outcomes in children with congenital heart disease: evaluation and management: a scientific statement from the American Heart Association. Circulation 126(9):1143–1172

    Article  PubMed  Google Scholar 

  36. Brosig C, Butcher J, Butler S, Ilardi DL, Sananes R, Sanz JH, Sood E, Struemph K, Ware J (2014) Monitoring developmental risk and promoting success for children with congenital heart disease: recommendations for cardiac neurodevelopmental follow-up programs. Clin Pract Pediatr Psychol 2(2):153

    Article  Google Scholar 

  37. Ijsselstijin H, Hunfeld M, Schiller RM, Houmes RJ, Hoskote A, Tibboel D, van Heijst AF (2018) Improving long-term outcomes after extracorporeal membrane oxygenation: from observational follow-up programs toward risk stratification. Front Pediatr 6:177

    Article  Google Scholar 

  38. Madderom MJ, Reuser JJ, Utens EM, van Rosmalen J, Raets M, Govaert P, Steiner K, Gischler SJ, Tibboel D, van Heijst AF (2013) Neurodevelopmental, educational and behavioral outcome at 8 years after neonatal ECMO: a nationwide multicenter study. Intensive Care Med 39(9):1584–1593

    Article  PubMed  Google Scholar 

  39. Madderom MJ, Schiller RM, Gischler SJ, van Heijst AF, Tibboel D, Aarsen FK, IJsselstijn H (2016) Growing up after critical illness: verbal, visual-spatial, and working memory problems in neonatal extracorporeal membrane oxygenation survivors. Crit Care Med 44(6):1182–1190

    Article  CAS  PubMed  Google Scholar 

  40. McGrath E, Wypij D, Rappaport LA, Newburger JW, Bellinger DC (2004) Prediction of IQ and achievement at age 8 years from neurodevelopmental status at age 1 year in children with D-transposition of the great arteries. Pediatrics 114(5):e572–e576

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported by the Kenrose Kitchen Foundation.

Author information

Authors and Affiliations

  1. Department of Psychiatry, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA, 02115, USA

    Anjali Sadhwani

  2. Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA

    Henry Cheng, Christian Stopp, Matthew A. Jolley, Carolyn Dunbar-Masterson, David Wypij, Jane Newburger & Ravi R. Thiagarajan

  3. Department of Neurology, Boston Children’s Hospital, Boston, MA, USA

    Caitlin K. Rollins

  4. Developmental Medicine Center, Boston Children’s Hospital, Boston, MA, USA

    Janice Ware

  5. The Departments of Psychiatry, Harvard Medical School, Boston, MA, USA

    Anjali Sadhwani & Janice Ware

  6. The Departments of Neurology, Harvard Medical School, Boston, MA, USA

    Caitlin K. Rollins

  7. The Departments of Pediatrics, Harvard Medical School, Boston, MA, USA

    David Wypij, Jane Newburger & Ravi R. Thiagarajan

  8. The Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    David Wypij

Authors
  1. Anjali Sadhwani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Henry Cheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Christian Stopp
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Caitlin K. Rollins
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Matthew A. Jolley
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Carolyn Dunbar-Masterson
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. David Wypij
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jane Newburger
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Janice Ware
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Ravi R. Thiagarajan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anjali Sadhwani.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in the study were in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 16 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sadhwani, A., Cheng, H., Stopp, C. et al. Early Neurodevelopmental Outcomes in Children Supported with ECMO for Cardiac Indications. Pediatr Cardiol 40, 1072–1083 (2019). https://doi.org/10.1007/s00246-019-02115-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00246-019-02115-1

Keywords

Search

Navigation