Functional Status Change Among Infants, Children, and Adolescents Following Extracorporeal Life Support: a Multicenter Report

Abstract

In our retrospective multicenter study of patients 0 to 18 years of age who survived extracorporeal life support (ECLS) between January 2010 and December 2018, we sought to characterize the functional status scale (FSS) of ECLS survivors, determine the change in FSS from admission to discharge, and examine risk factors associated with development of new morbidity and unfavorable outcome. During the study period, there were 1,325 ECLS runs, 746 (56%) survived to hospital discharge. Pediatric patients accounted for 56%. Most common ECLS indication was respiratory failure (47%). ECLS support was nearly evenly split between veno-arterial and veno-venous (51% vs. 49%). Median duration of ECLS in survivors was 5.5 days. Forty percent of survivors had new morbidity, and 16% had an unfavorable outcome. In a logistic regression, African American patients (OR 1.68, p = 0.01), longer duration of ECLS (OR 1.002, p = 0.004), mechanical (OR 1.79, p = 0.002), and renal (OR 1.64, p = 0.015) complications had higher odds of new morbidity. Other races (Pacific Islanders, and Native Americans) (OR 2.89, p = 0.013), longer duration of ECLS (OR 1.002, p = 0.002), and mechanical complications (OR 1.67, p = 0.026) had higher odds of unfavorable outcomes. In conclusion, in our multi-center 9-year ECLS experience, 56% survived, 40% developed new morbidity, and 84% had favorable outcome. Future studies with larger populations could help identify modifiable risk factors that could help guide clinicians in this fragile patient population.

Health Disparities in Extracorporeal Membrane Oxygenation Utilization and Outcomes: A Scoping Review and Methodologic Critique of the Literature*

“…Of citations identifying adverse outcomes, 8 (22%) used univariate (77–84) and 28 (78%) used multivariate analyses. Of multivariate analyses, diverse populations, compared with nondiverse/White patients, were independently associated with mortality (26, 27, 29, 30, 32, 35, 85–100), adverse neurologic outcomes (101), or prolonged ECMO duration (34). One study showed higher adjusted mortality in patients with Hispanic ethnicity compared with Asian (102).…”

Short-Term Outcomes, Functional Status, and Risk Factors for Requiring Extracorporeal Life Support After Norwood Operation: A Single-Center Retrospective Study

“…Beshish et al . 14 reported in a separate multicenter study examining functional outcomes of patients following ECLS, 746 of the 1,325 patients (56%) survived to hospital discharge, 40% developed new-morbidity and 84% had favorable outcomes. Of this cohort, 31% (n = 228) were cardiac ECLS.…”

“…Beshish et al 13 reported patients who required extracorporeal cardiopulmonary resuscitation (E-CPR) in a pediatric CICU showed that 48% survived to hospital discharge, with 50% developed new morbidity and 32% developed unfavorable outcomes. Beshish et al 14 reported in a separate multicenter study examining functional outcomes of patients following ECLS, 746 of the 1,325 patients (56%) survived to hospital discharge, 40% developed new-morbidity and 84% had favorable outcomes. Of this cohort, 31% (n = 228) were cardiac ECLS.…”

“…This was operationalized by assigning a baseline FSS score of 6 to all admissions for infants 0-2 days old and to transfers from another facility for infants 3-6 days old as previously reported. [12][13][14][15] New-morbidity was defined as an increase in the total FSS score of 3 points or more from admission, whereas unfavorable functional outcomes were defined as an increase in total FSS score of 5 points or more from admission as described by Pollack et al 16…”

Functional status of pediatric patients after extracorporeal membrane oxygenation: A five-year single-center study

“…However, with the rising number of survivors, complications and long-term clinical outcomes have become an important public health concern with reported mortality rates at discharge, 1, 2, and 5 years after ECMO initiation of 40, 45.1, 49.0and 57.4%, respectively, while among the survivors, 21.2% were discharged to continuing care ( 3 ). A recent multicenter study found that 56% of the patients who received ECMO treatment survived until hospital discharge, and a new morbidity was found in 40% of the survivors with the Functional Status Scale (FSS), increasing from 6.5 to 9.1 ( 4 ). Another study found that the mean FSS of the sepsis patients who received ECMO treatment deteriorated from baseline and the survivors still had problems, such as small acute subarachnoid hemorrhage or massive intraparenchymal hemorrhage centered in the left frontal lobe, and 50% of the survivors needed rehabilitation after discharge ( 5 ).…”