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Eur J Cardiothorac Surg 2004;26:38-43
© 2004 Elsevier Science NL
a Division of Neurology, The Hospital for Sick Children, University of Toronto, Toronto, Ont., Canada
b Division of Cardiovascular Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ont., Canada
c Division of Neuroradiology, The Hospital for Sick Children, University of Toronto, Toronto, Ont., Canada
d Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, Ont., Canada
e Department of Critical Care Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ont., Canada
f Department of Cardiovascular Perfusion, The Hospital for Sick Children, University of Toronto, Toronto, Ont., Canada
Received 8 September 2003; received in revised form 8 April 2004; accepted 9 April 2004.
* Corresponding author. Address: University Hospital, Queen's Medical Centre, Nottingham, NG7 2UH, UK. Tel.: +44-115-924-9924x43328; fax: +44-115-970-9763
e-mail: gcschow{at}hotmail.com
Objectives: The objective of this study was to determine the incidence and risk factors for death and adverse neurological outcomes in children receiving extracorporeal life support (ECLS) for cardiac indications. Methods: A retrospective single centre consecutive cohort study was conducted in children who received ECLS for cardiac indications between January 1990 and June 2000. Health records and neuroimaging films were assessed, and long-term outcomes were obtained by standardized telephone follow-up or by assessments performed in outpatient clinic. Clinical, neuroimaging and surgical predictors of outcome were tested. Results: Of 90 children studied, short-term clinical neurological events (during hospitalization) occurred in 20 children (22%) during or following ECLS. Long-term neurological sequelae were present in 11 of 31 children discharged alive, after a mean follow-up interval of 4.5 years (range 4 months to 9 years). Death occurred in 59 children (66%) during hospitalisation, and in 3 following discharge. Of the 28 long-term survivors, only 15 children (17%) survived without neurological sequelae. Abnormal neuroimaging was associated with short-term neurological events (P=0.03, OR 10.5), and the use of CPR prior to ECLS (P=0.02, OR 2.9) was the only significant predictor of death. There were no significant predictors of long-term neurological sequelae. Conclusions: More than two-thirds of the children receiving ECLS died, and 39% (11/28) of long-term survivors had neurological deficits. Although mortality is close to 100% without this type of support, there is still a significantly high morbidity and mortality with this type of support.
Key Words: Extracorporeal life support • Predictors • Neurological sequelae
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