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Neurologic Outcomes in a Two-Center Cohort of Neonatal and Pediatric Patients Supported on Extracorporeal Membrane Oxygenation

Bembea, Melania M.*,†; Felling, Ryan J.; Caprarola, Sherrill D.§; Ng, Derek; Tekes, Aylin; Boyle, Katharine*; Yiu, Alvin*; Rizkalla, Nicole*; Schwartz, Jamie*; Everett, Allen D.; Salorio, and Cynthia#,**

doi: 10.1097/MAT.0000000000000933
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Contemporary studies of long-term outcomes in children supported on extracorporeal membrane oxygenation (ECMO) in the United States are limited. We enrolled 99 ECMO patients between July 2010 and June 2015 in a two-center prospective observational study that included neurologic and neuropsychologic evaluation at 6 and 12 months, using standardized outcome measures. Pre-ECMO, 20 (20%) had a pre-existing neurologic diagnosis, 40 (40%) had cardiac arrest, and 10 of 47 (21%) children with neuroimaging had acute abnormal findings. Of 50 children eligible for follow-up at 6 or 12 months, 40 (80%) returned for at least one visit. At the follow-up visit of longest interval from ECMO, the median Vineland Adaptive Behavior Scales-II (VABS-II) score was 91 (interquartile range [IQR], 81–98), the median Pediatric Stroke Outcome Measure (PSOM) score was 1 (IQR, 0–2), and the median Mullen Scales of Early Learning composite score was 85 (IQR, 72–96). Presence of new neuroimaging abnormalities during ECMO or within 6 weeks post-ECMO was associated with VABS-II score <85 or death within 12 months after ECMO. The Pediatric Cerebral Performance Category at hospital discharge showed a strong relationship with unfavorable VABS-II and PSOM scores at 6 or 12 months after ECMO. In this study, we report a higher prevalence of pre-ECMO neurologic conditions than previously described. In survivors to hospital discharge, median scores for adaptive behavior and cognitive, neurologic, and quality of life assessments were all below the general population means, but most deficits would be considered minor within each of the domains tested.

From the *Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland

Department of Pediatrics, Division of Cardiac Critical Care, Johns Hopkins University, Baltimore, Maryland

Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland

§Department of Pediatrics, Children’s National Health System, Washington, DC

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland

#Kennedy Krieger Institute, Baltimore, Maryland

**Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Submitted for consideration August 2018; accepted for publication in revised form November 2018.

Disclosures: The authors have no conflicts of interest to report.

Support for this work included funding from the National Institute of Neurological Disorders and Stroke of the National Institutes of Health under Award Number K23NS076674 (MMB). This work was supported by U54 HD079123.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (www.asaiojournal.com)

Copyright © 2019 by the American Society for Artificial Internal Organs