Extracorporeal Life Support Organization (ELSO) Guidelines for Follow-up After Neonatal and Pediatric Extracorporeal Membrane Oxygenation

Abstract

Neonates and children who have survived critical illness severe enough to require extracorporeal membrane oxygenation (ECMO) are at risk for neurologic insults, neurodevelopmental delays, worsening of underlying medical conditions, and development of new medical comorbidities. Structured neurodevelopmental follow-up is recommended for early identification and prompt interventions of any neurodevelopmental delays. Even children who initially survive this critical illness without new medical or neurologic deficits remain at risk of developing new morbidities/delays at least through adolescence, highlighting the importance of structured follow-up by personnel knowledgeable in the sequelae of critical illness and ECMO. Structured follow-up should be multifaceted, beginning predischarge and continuing as a coordinated effort after discharge through adolescence. Predischarge efforts should consist of medical and neurologic evaluations, family education, and co-ordination of long-term ECMO care. After discharge, programs should recommend a compilation of pediatric care, disease-specific care for underlying or acquired conditions, structured ECMO/neurodevelopmental care including school performance, parental education, and support. Institutionally, regionally, and internationally available resources will impact the design of individual center's follow-up program. Additionally, neurodevelopmental testing will need to be culturally and lingually appropriate for centers' populations. Thus, ECMO centers should adapt follow-up program to their specific populations and resources with the predischarge and postdischarge components described here.

ECMO in neonates: The association between cerebral hemodynamics with neurological function

“…But there is still considerable heterogeneity in the available studies in terms of the long-term neurological outcomes, and there is currently no clear evidence pointing to the superiority of either reconstruction or ligation ( 56 – 59 ). It is imperative to provide more definitive clinical decisions on vascular management by a standardized follow-up program ( 60 ), and more prospective studies are needed to evaluate the correlation between cerebral hemodynamics and neurological function.…”

Extracorporeal membrane oxygenation in children: A brief review

“…Neuropsychological issues are present in quarter neonatal ECMO survivors with long-lasting effects on their academic performance. 31 Although their neurodevelopment seems favourable in the initial years, some of these children experience difficulties with memory, working speed and spatial ability tasks. 32 There are reports of poorer physical function at 36 months, 32,33 with a significant proportion of patients with learning difficulties.…”

“…The current ELSO guidelines suggest that all ECMO survivors should have long‐term follow‐up in a structured and standardised approach 31 . Long‐term follow‐up should be individualised depending on the availability of resources, indication for ECMO, nature of underlying disease and presence of other comorbidities.…”

Veno-Arterial Extracorporeal Membrane Oxygenation (ECMO) Impairs Bradykinin-Induced Relaxation in Neonatal Porcine Coronary Arteries

“…Unfortunately, data on the long-term medical outcomes of neonatal ECMO survivors are limited and chronic cardiovascular complications, such as hypertension, are recognized mainly as secondary to chronic kidney injury [ 53 ]. For this reason, the cardiovascular outcome is not yet included in the long-term recommendations for follow-up after neonatal ECMO, focusing more on neurocognitive, motor, sensory, and growth outcomes [ 54 ]. In addition, an extensive patient cohort would be necessary to verify how treatment with extracorporeal circulation could affect chronic endothelial diseases, especially atherosclerosis.…”