G. J. Ares1,2, C. Buonpane2, I. Helenowski3, F. Hebal2, C. J. Hunter2 1University Of Illinois At Chicago,Department Of Surgery,Chicago, IL, USA 2Ann & Robert H. Lurie Children’s Hospital Of Chicago,Division Of Pediatric Surgery,Chicago, IL, USA 3Northwestern University,Department Of Surgery,Chicago, IL, USA
Introduction:
Extracorporeal membrane oxygenation (ECMO) has been used as a rescue intervention in neonates and infants in acute cardiopulmonary failure. However, these patients are at high risk for long term morbidity including neurologic dysfunction and mortality. While survival has been reported with ECMO courses >14 days, no studies have looked at meaningful survival and recovery after prolonged ECMO >21 days which has been cited as an arbitrary cut-off time in some centers. We hypothesized that patients with prolonged ECMO courses (>21 days) would have poor overall survival and quality of life.
Methods:
We performed a single institution, retrospective review of medical records for patients <18 years old receiving ECMO for >/= 21 days for any indication, between the years 2007 and 2017. The primary outcome was survival to hospital discharge. Secondary outcomes included neurologic dysfunction and other morbidities documented following the initial hospitalization.
Results:
Fourteen patients met inclusion criteria. Survival to hospital discharge for this group was 36%, which is significantly lower than the reported 60% survival for children requiring ECMO <14 days. Patients who started ECMO after 100 days of age were more likely to survive (p=0.03). Patients requiring ECMO support for congenital cardiac or pulmonary conditions had decreased survival compared to those with acquired etiologies (2/2 patients with acquired cardiac failure, and 3/6 patients with acquired pulmonary indication for ECMO survived, compared to 0/6 survivors for congenital cardiac or pulmonary etiologies (p=0.03)). Patients who were progressively weaned from ECMO support were more likely to survive, compared to those who discontinued ECMO secondary to minimal progress or circuit complications (p=0.005). Only 1 of the 5 survivors made a full recovery without residual neurologic deficits. The other 4 had adverse neurologic outcomes, including ischemic/hemorrhagic stroke, behavioral and learning disabilities, extremity amputation or contractures impairing ambulation, epilepsy, cortical blindness, sensorineural hearing loss, and/or inability to achieve pulmonary independence.
Conclusion:
Prolonged ECMO courses of >21 days are associated with decreased survival to hospital discharge. There are minimal data to support prolongation of ECMO for neonates with congenital cardiac or pulmonary failure. Furthermore, long term outcomes for prolonged ECMO survivors are characterized by neurologic impairments, learning disabilities, and impaired mobility. These need to be considered with families in the discussion to justify prolonged support.