Neurologic outcome in children after extracorporeal membrane oxygenation: Prognostic value of diagnostic tests

• Published in: Pediatric neurology 2005-03, Vol.32 (3), p.173-179
• Main Authors: Amigoni, Angela, Pettenazzo, Andrea, Biban, Paolo, Suppiej, Agnese, Freato, Federica, Zaramella, Patrizia, Zacchello, Franco
• Format: Article
• Language: English
• Subjects: Adolescent; Biological and medical sciences; Cerebral Cortex - pathology; Cerebral Cortex - physiopathology; Child; Child Development - physiology; Child, Preschool; Developmental Disabilities - etiology; Electrodiagnosis. Electric activity recording; Electroencephalography; Evoked Potentials - physiology; Extracorporeal Membrane Oxygenation; Follow-Up Studies; Glasgow Outcome Scale; Humans; Infant; Investigative techniques, diagnostic techniques (general aspects); Medical sciences; Nervous system; Nervous system (semeiology, syndromes); Nervous system as a whole; Nervous System Diseases - etiology; Neurology; Predictive Value of Tests; Prospective Studies; Recovery of Function - physiology; Treatment Outcome; Wechsler Scales
• ISSN: 0887-8994; 1873-5150
• DOI: 10.1016/j.pediatrneurol.2004.10.002

This report presents the long-term (36 months) neurologic outcome in 12 neonates and 9 children who survived after extracorporeal membrane oxygenation and attempts to identify its prognostic indicators through a prospective study in the pediatric intensive care unit of a university hospital. Outcome assessment, neurodevelopmental tests, electroencephalogram, auditory evoked potentials, visual evoked potentials, and somatosensory evoked potentials, cerebral sonography, or cerebral tomography were evaluated at the end of bypass and at 6, 12, 24, and 36 months after extracorporeal membrane oxygenation. “Before extracorporeal membrane oxygenation” variables (oxygenation index, pH, oxygen arterial partial pressure) and “during extracorporeal membrane oxygenation” variables (pH, oxygen arterial partial pressure, duration of bypass, clotting activated time, electroencephalogram) were also analyzed. A negative neurologic outcome (Glasgow Outcome Score different from “good recovery” or neurodevelopmental score less than 70) 12 months after extracorporeal membrane oxygenation was documented in 8.3% of neonates and in 30% of children who survived. There was no further change in subsequent evaluations (24 and 36 months follow-up). The most abnormal electroencephalogram during extracorporeal membrane oxygenation, the first electroencephalogram, neuroimaging score, and somatosensory evoked potentials after extracorporeal membrane oxygenation treatment were associated with negative neurologic outcome. The study documented that neonates and children treated with extracorporeal membrane oxygenation require long-term follow-up; electroencephalogram, neuroimaging score, and somatosensory evoked potentials have prognostic value for abnormal neurologic outcome.