Neurologic Outcomes After Extracorporeal Membrane Oxygenation—A Systematic Review

Objectives: The goal of this systematic review of the literature was to summarize neurologic outcomes following neonatal and pediatric extracorporeal membrane oxygenation. Data Sources: We conducted electronic searches of PubMed, Scopus, Web of Science, CINAHL, Cochrane, and EMBASE. Study Selection: Inclusion criteria included publication dates 2000–2016, patient ages 0–18 years, and use of standardized measures to evaluate outcomes after extracorporeal membrane oxygenation. Data Extraction: We identified 3,497 unique citations; 60 full-text articles were included in the final review. Data Synthesis: Studies evaluated patients with congenital diaphragmatic hernia (7), cardiac disease (8), cardiac arrest (13), and mixed populations (32). Follow-up was conducted at hospital discharge in 10 studies (17%) and at a median of 26 months (interquartile range, 8–61 mo) after extracorporeal membrane oxygenation in 50 studies (83%). We found 55 outcome measures that assessed overall health and function (4), global cognitive ability (7), development (4), motor function (5), adaptive function (2), behavior/mood (6), hearing (2), quality of life (2), school achievement (5), speech and language (6), learning and memory (4), and attention and executive function (8). Overall, 10% to as many as 50% of children scored more than 2 SDS below the population mean on cognitive testing. Behavior problems were identified in 16–46% of children tested, and severe motor impairment was reported in 12% of children. Quality of life of former extracorporeal membrane oxygenation patients evaluated at school age or adolescence ranged from similar to healthy peers, to 31–53% having scores more than 1 SD below the population mean. Conclusions: This systematic review of the literature suggests that children who have undergone extracorporeal membrane oxygenation suffer from a wide range of disabilities. A meta-analysis was not feasible due to heterogeneity in pathologies, outcome measures, and age at follow-up, underscoring the importance of developing and employing a core set of outcomes measures in future extracorporeal membrane oxygenation studies. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (https://ift.tt/2gIrZ5Y). Supported, in part, by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health under Award Number K23NS076674 (to Dr. Bembea). Dr. Bembea’s institution received funding from the National Institutes of Health (NIH)/National Institute of Neurological Disorders and Stroke K23NS076674; she received support for article research from the NIH; and she disclosed off-label product use of extracorporeal membrane oxygenation (not U.S. Food and Drug Administration approved for longer than 6 hr). The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: kboyle14@jhmi.edu ©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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