Abstract 9173: Neurological and Cardiac Functional Status After Extracorporeal Membrane Oxygenation in Children with Heart Disease

Abstract

Introduction: There are limited outcomes data following hospital discharge after extracorporeal membrane oxygenation (ECMO) in children with heart disease. Hypothesis: Children with heart disease who are hospital survivors of ECMO have ongoing mortality, but minimal functional residua. Methods: We reviewed data of all children with heart disease receiving venoarterial ECMO for a cardiac indication between 2001-2008. Pre-ECMO characteristics, ECMO details, complications and outcomes were abstracted from institutional databases and medical records. Univariate and multivariable analyses to determine factors associated with hospital survival and neurological outcomes using the Pediatric Cerebral Performance Category (PCPC) score were performed. Results: 184 ECMO episodes (163 patients) occurred at a median ( 25 th , 75 th %ile) age of 0.36 (0.04, 2.2) years; indications were cardiomyopathy (22%) and post-cardiotomy (66%). Cardiac arrest prompted 100 (54%) ECMO episodes in 86 patients. The median duration of CPR was 31 minutes. The median ECMO duration was 4 days. ECMO complications included intracranial hemorrhage (22%), ischemic brain injury (27%), seizures (27%), pulmonary or gastrointestinal bleeding (15%) and need for renal replacement therapy (49%). Of the total inception cohort, 63 (41%) survived to hospital discharge; 58 (36%) were alive at a median follow-up of 3.6 years with the majority (81%) having a PCPC score ≤ 2. Of the 86 patients who had cardiac arrest, 28 (33%) survived to hospital discharge; 22 (26%) were alive at a median follow-up of 3 years with the majority (81%) having a PCPC score ≤ 2. At follow-up, 55 (82%) were in pediatric NYHA Class ≤ 2 heart failure. Factors associated with hospital survival were cardiomyopathy (OR=2.2, p=0.01) and biventricular physiology (OR=1.9, p=0.006). A pre-ECMO diagnosis of cardiomyopathy was associated with a lower PCPC score at 6 months (EST: -0.24, p=0.0007), while ECMO for cardiac arrest was associated with a higher PCPC score at (EST: 0.16, p=0.008) 6 month follow-up. Conclusion: Children with heart disease who survive to hospital discharge after ECMO have ongoing early mortality; despite these concerns, survivors have good quality neurological outcome and cardiac functional status.