Understanding the ECMO, Recovery, and Outcome Experience of Pediatric Respiratory ECMO Survivors
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Cardiovascular, Procedures, Pediatrics, 2022
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INTRODUCTION: As more children survive extracorporeal membrane oxygenation (ECMO) for severe cardiopulmonary failure, morbidity has been emphasized as an important outcome in this population. Neurodevelopmental problems have been recognized in cardiac and neonatal ECMO survivors through established follow-up programs. Less is known about these problems, as well as related challenges faced by patients and families, after respiratory ECMO. Better understanding of the recovery course after respiratory ECMO is essential to inform follow-up guidelines and counseling provided by critical care physicians. METHODS: Cross-sectional, mixed-methods study of respiratory ECMO survivors from a regional pediatric ECMO referral center. All survivors less than 21 years who received ECMO for respiratory failure in the PICU from 2014 to 2020 were eligible for inclusion. Neonates and children who required ECMO for cardiac indications or during CPR were excluded. Parental experiences of ECMO and the recovery period were explored via semi-structured telephone interviews. Functional status was assessed via the Vineland Adaptive Behavior Scales (VABS-3) Parent/Caregiver Form. RESULTS: Of 300 ECMO patients, 96 (32%) required ECMO for respiratory indications, of whom 22 (23%) survived to discharge and were eligible for inclusion. Age at ECMO ranged from 3 months to 20 years. Diagnoses included ARDS (45%), pulmonary hypertension (32%), status asthmaticus (9%), airway pathology (9%), and cystic fibrosis (5%). Fifteen patients (68%) were successfully contacted and 10 interviews completed. Common themes included the desire for anticipatory communication before ECMO, uncertainty regarding functional outcome, parental psychosocial stress, and variability in follow-up services provided. VABS-3 results varied widely, with survivor mean scores approximately 1.5 SD below population norms across each subdomain and overall (mean overall score 79.0, range 53-111). CONCLUSION: Children who survive respiratory ECMO share common challenges around functional rehabilitation, parental psychosocial stress, and uncertainty about expectations following ECMO. Functional scores are generally below population norms, but cover a wide range. Increased understanding of these challenges and limitations will enable us to better advise families during and after ECMO.
Meta Tag
Content Type Presentation
Knowledge Area Cardiovascular
Knowledge Area Procedures
Knowledge Area Pediatrics
Knowledge Level Intermediate
Knowledge Level Advanced
Membership Level Select
Tag Extracorporeal Membrane Oxygenation ECMO
Tag Pediatrics
Tag Extracorporeal Life Support
Tag Outcomes Research
Tag Respiratory Failure
Tag Cardiothoracic Critical Care
Year 2022
Claire Hennigan
pediatric respiratory ECMO survivors
treatment for respiratory or circulatory failure
functional outcomes
experiences of survivors and parents


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