Lindsay M Ryerson1, Gonzalo Garcia Guerra2, Ari R Joffe2, Charlene M T Robertson2, Gwen Y Alton2, Irina A Dinu2, Don Granoski2, Ivan M Rebeyka2, David B Ross2, Laurance Lequier2. 1. From the Department of Pediatrics (L.M.R., G.G.G., A.R.J., C.M.T.R., L.L.), Department of Public Health Sciences (I.A.D.), and Department of Surgery (I.M.R., D.B.R.), University of Alberta, Edmonton, Alberta, Canada; Pediatric Rehabilitation Outcomes Evaluation and Research Unit, Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada (C.M.T.R., G.Y.A.); and Pediatric Critical Care Unit, Stollery Children's Hospital, Edmonton, Alberta, Canada (D.G.). ryerson@ualberta.ca. 2. From the Department of Pediatrics (L.M.R., G.G.G., A.R.J., C.M.T.R., L.L.), Department of Public Health Sciences (I.A.D.), and Department of Surgery (I.M.R., D.B.R.), University of Alberta, Edmonton, Alberta, Canada; Pediatric Rehabilitation Outcomes Evaluation and Research Unit, Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada (C.M.T.R., G.Y.A.); and Pediatric Critical Care Unit, Stollery Children's Hospital, Edmonton, Alberta, Canada (D.G.).
Abstract
BACKGROUND: Survival after pediatric cardiac extracorporeal life support (ECLS) is guarded, and neurological morbidity varies widely. Our objective is to report our 10-year experience with cardiac ECLS, including survival and kindergarten entry neurocognitive outcomes; to identify predictors of mortality or adverse neurocognitive outcomes; and to compare 2 eras, before and after 2005. METHODS AND RESULTS: From 2000 to 2009, 98 children had venoarterial cardiac ECLS. Sixty-four patients (65%) survived to hospital discharge, and 50 (51%) survived ≤5 years of age. Neurocognitive follow-up of survivors was completed at mean (SD) age of 52.9 (8) months using Wechsler Preschool and Primary Scale of Intelligence. Logistic regression analysis found the longer time (hours) for lactate to fall below 2 mmol/L on ECLS (hazard ratio, 1.39; 95% confidence interval, 1.05, 1.84; P=0.022), and the amount of platelets (mL/kg) given in the first 48 hours (hazard ratio, 1.18; 95% confidence interval, 1.06, 1.32; P=0.002) was independently associated with higher in-hospital mortality. Receiving ECLS after the year 2005 was independently associated with lower risk of in-hospital mortality (hazard ratio, 0.36; 95% confidence interval, 0.13, 0.99; P=0.048). Extracorporeal cardiopulmonary resuscitation was not independently associated with mortality or neurocognitive outcomes. Era was not independently associated with neurocognitive outcomes. The full-scale intelligence quotient of survivors without chromosomal abnormalities was 79.7 (16.6) with 25% below 2 SD of the population mean. CONCLUSIONS: Mortality has improved over time; time for lactate to fall on ECLS and volume of platelets transfused are independent predictors of mortality. Extracorporeal cardiopulmonary resuscitation and era were not independently associated with neurocognitive outcomes.
BACKGROUND: Survival after pediatric cardiac extracorporeal life support (ECLS) is guarded, and neurological morbidity varies widely. Our objective is to report our 10-year experience with cardiac ECLS, including survival and kindergarten entry neurocognitive outcomes; to identify predictors of mortality or adverse neurocognitive outcomes; and to compare 2 eras, before and after 2005. METHODS AND RESULTS: From 2000 to 2009, 98 children had venoarterial cardiac ECLS. Sixty-four patients (65%) survived to hospital discharge, and 50 (51%) survived ≤5 years of age. Neurocognitive follow-up of survivors was completed at mean (SD) age of 52.9 (8) months using Wechsler Preschool and Primary Scale of Intelligence. Logistic regression analysis found the longer time (hours) for lactate to fall below 2 mmol/L on ECLS (hazard ratio, 1.39; 95% confidence interval, 1.05, 1.84; P=0.022), and the amount of platelets (mL/kg) given in the first 48 hours (hazard ratio, 1.18; 95% confidence interval, 1.06, 1.32; P=0.002) was independently associated with higher in-hospital mortality. Receiving ECLS after the year 2005 was independently associated with lower risk of in-hospital mortality (hazard ratio, 0.36; 95% confidence interval, 0.13, 0.99; P=0.048). Extracorporeal cardiopulmonary resuscitation was not independently associated with mortality or neurocognitive outcomes. Era was not independently associated with neurocognitive outcomes. The full-scale intelligence quotient of survivors without chromosomal abnormalities was 79.7 (16.6) with 25% below 2 SD of the population mean. CONCLUSIONS: Mortality has improved over time; time for lactate to fall on ECLS and volume of platelets transfused are independent predictors of mortality. Extracorporeal cardiopulmonary resuscitation and era were not independently associated with neurocognitive outcomes.
Authors: José A Hordijk; Sascha C Verbruggen; Corinne M Buysse; Elisabeth M Utens; Koen F Joosten; Karolijn Dulfer Journal: Qual Life Res Date: 2022-03-31 Impact factor: 3.440
Authors: Hanneke IJsselstijn; Maayke Hunfeld; Raisa M Schiller; Robert J Houmes; Aparna Hoskote; Dick Tibboel; Arno F J van Heijst Journal: Front Pediatr Date: 2018-06-26 Impact factor: 3.418
Authors: Gabriela A Kuraim; Daniel Garros; Lindsay Ryerson; Fahimeh Moradi; Irina A Dinu; Gonzalo Garcia Guerra; Diane Moddemann; Gwen Y Bond; Charlene M T Robertson; Ari R Joffe Journal: J Intensive Care Date: 2018-09-03