Improving Long-Term Outcomes After Extracorporeal Membrane Oxygenation: From Observational Follow-Up Programs Toward Risk Stratification

IJsselstijn, Hanneke; Hunfeld, Maayke; Schiller, Raisa M.; Houmes, Robert Jan; Hoskote, Aparna; Tibboel, Dick; Heijst, Arno F J van

doi:10.3389/fped.2018.00177

Cited by 47 publications

(28 citation statements)

References 104 publications

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“…Third, while we did provide data related to survival and costs incurred following discharge, we did not have data related to quality of life and family burden following discharge. Existing evidence highlights the significant long-term morbidity seen in similar populations [39]. Finally, while the databases held at ICES are robust and have been used extensively for large population-based studies [13,40], there are inherent limitations to the available administrative data.…”

Section: Discussionmentioning

confidence: 99%

Long-term survival and costs following extracorporeal membrane oxygenation in critically ill children—a population-based cohort study

Fernando¹,

Qureshi²,

Tanuseputro³

et al. 2020

Crit Care

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Background: Extracorporeal membrane oxygenation (ECMO) is used to provide temporary cardiorespiratory support to critically ill children. While short-term outcomes and costs have been evaluated in this population, less is known regarding long-term survival and costs. Methods: Population-based cohort study from Ontario, Canada (October 1, 2009 to March 31, 2017), of pediatric patients (< 18 years of age) receiving ECMO, identified through the use of an ECMO procedural code. Outcomes were identified through linkage to provincial health databases. Primary outcome was survival, measured to hospital discharge, as well as at 1 year, 2 years, and 5 years following ECMO initiation. We evaluated total patient costs in the first year following ECMO. Results: We analyzed 342 pediatric patients. Mean age at ECMO initiation was 2.9 years (standard deviation [SD] = 5.0). Median time from hospital admission to ECMO initiation was 5 days (interquartile range [IQR] = 1-13 days). Overall survival to hospital discharge was 56.4%.

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Section: Discussionmentioning

confidence: 99%

Long-term survival and costs following extracorporeal membrane oxygenation in critically ill children—a population-based cohort study

Fernando¹,

Qureshi²,

Tanuseputro³

et al. 2020

Crit Care

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“…Most follow-up studies in neonates and children who survived ECMO treatment have been cross-sectional, mono-center and in small study populations. With the current shift toward long-term multidisciplinary evaluations, observational follow-up-programs should be transferred toward risk stratification (60).…”

Section: Improving Long-term Outcome Of Cdh Via Structured Follow Upmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation in Congenital Diaphragmatic Hernia

Rafat

Schaible

2019

Front. Pediatr.

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Congenital diaphragmatic hernia (CDH) is characterized by failure of diaphragmatic development with lung hypoplasia and persistent pulmonary hypertension of the newborn (PPHN). If conventional treatment with gentle ventilation and optimized vasoactive medication fails, extracorporeal membrane oxygenation (ECMO) may be considered. The benefits of ECMO in CDH are still controversial, since there are only few randomized trials demonstrating the advantages of this therapeutic option. At present, there is no precise prenatal and/or early postnatal prognostication parameter to predict reversibility of PPHN in CDH patients. Indications for initiating ECMO include either respiratory or circulatory parameters, which are also undergoing continuous refinement. Centers with higher case numbers and the availability of ECMO published promising survival rates, but data on long-term results, including morbidity and quality of life, are rare. Survival might be influenced by the timing of ECMO initiation and the timing of surgical repair. In this regard a trend toward early initiation of ECMO and early surgery on ECMO exists. The results concerning the cannulation modes are similar and a consensus on time limit for ECMO runs does not exist. The use of ECMO in CDH will continue to be evaluated, and prospective randomized trials and registry network are necessary to help answering the addressed questions of patient selection and management.

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“…A multidisciplinary approach to long-term follow-up after neonatal critical illness should therefore be strived for. Please refer to IJsselstijn et al (52) for more detailed recommendations on multidisciplinary age-appropriate follow-up programs in these patients.…”

Section: Future Directions To Improve Neurodevelopment After Neonatalmentioning

confidence: 99%

Neurocognitive Outcome After Treatment With(out) ECMO for Neonatal Critical Respiratory or Cardiac Failure

Schiller

Tibboel

2019

Front. Pediatr.

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Over the years, it has become clear that children growing up after neonatal critical illness are at high risk of long-term neurocognitive deficits that impact their school performance and daily life activities. Although the pathophysiological mechanisms remain largely unknown, emerging evidence seems to suggest that long-term neuropsychological deficits following neonatal critical illness are not associated with the type of treatment, such as extracorporeal membrane oxygenation (ECMO), but rather with underlying disease processes. In this review, neurocognitive outcome and brain pathology following neonatal critical respiratory and cardiac illness, either treated with or without ECMO, are described and compared in order to gain insight into potential underlying pathophysiological mechanisms. Putting these findings together, it becomes apparent that both children with complex congenital heart disease and children who survived severe respiratory failure are at risk of neurocognitive deficits later in life. Neurorehabilitation strategies, such as Cogmed working-memory training, are discussed. While prevention of neurocognitive deficits altogether should be strived for in the future, this is not realistic at this moment. It is therefore of great importance that children growing up after neonatal critical illness receive long-term care that includes psychoeducation and personalized practical tools that can be used to improve their daily life activities.

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Improving Long-Term Outcomes After Extracorporeal Membrane Oxygenation: From Observational Follow-Up Programs Toward Risk Stratification

Cited by 47 publications

References 104 publications

Long-term survival and costs following extracorporeal membrane oxygenation in critically ill children—a population-based cohort study

Long-term survival and costs following extracorporeal membrane oxygenation in critically ill children—a population-based cohort study

Extracorporeal Membrane Oxygenation in Congenital Diaphragmatic Hernia

Neurocognitive Outcome After Treatment With(out) ECMO for Neonatal Critical Respiratory or Cardiac Failure

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