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World J Crit Care Med. Nov 4, 2013; 2(4): 40-47
Published online Nov 4, 2013. doi: 10.5492/wjccm.v2.i4.40
Neurologic complications and neurodevelopmental outcome with extracorporeal life support
Amit Mehta, Laura M Ibsen
Amit Mehta, Laura M Ibsen, Division of Pediatric Critical Care Medicine, Department of Pediatrics, Oregon Health and Sciences University, Portland, OR 97239, United States
Author contributions: Mehta A, Ibsen LM wrote the paper.
Correspondence to: Amit Mehta, MD, Division of Pediatric Critical Care Medicine, Department of Pediatrics, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States. mehtaa@ohsu.edu
Telephone: +1-503-4949000 Fax: +1-503-4944951
Received: July 10, 2013
Revised: July 27, 2013
Accepted: August 4, 2013
Published online: November 4, 2013
Processing time: 113 Days and 8.7 Hours
Abstract

Extracorporeal life support is used to support patients of all ages with refractory cardiac and/or respiratory failure. Extracorporeal membrane oxygenation (ECMO) has been used to rescue patients whose predicted mortality would have otherwise been high. It is associated with acute central nervous system (CNS) complications and with long- term neurologic morbidity. Many patients treated with ECMO have acute neurologic complications, including seizures, hemorrhage, infarction, and brain death. Various pre-ECMO and ECMO factors have been found to be associated with neurologic injury, including acidosis, renal failure, cardiopulmonary resuscitation, and modality of ECMO used. The risk of neurologic complication appears to vary by age of the patient, with neonates appearing to have the highest risk of acute central nervous system complications. Acute CNS injuries are associated with increased risk of death in a patient who has received ECMO support. ECMO is increasingly used during cardiopulmonary resuscitation when return of spontaneous circulation is not achieved rapidly and outcomes may be good in select populations. Economic analyses have shown that neonatal and adult respiratory ECMO are cost effective. There have been several intriguing reports of active physical rehabilitation of patients during ECMO support that is well tolerated and may improve recovery. Although there is evidence that some patients supported with ECMO appear to have very good outcomes, there is limited understanding of the long-term impact of ECMO on quality of life and long-term cognitive and physical functioning for many groups, especially the cardiac and pediatric populations. This deserves further study.

Keywords: Respiratory failure; Cardiopulmonary resuscitation; Pediatrics; Extracorporeal life support; Congenital heart disease; Stroke

Core tip: Extracorporeal life support is used to support patients of all ages with refractory cardiac and/or respiratory failure. It is associated with acute central nervous system complications and with long- term neurologic morbidity. Many patients treated with extracorporeal membrane oxygenation (ECMO) have acute neurologic complications, including seizures, hemorrhage, infarction, and brain death. In this review paper, we review the incidence of and factors associated with neurologic complications associated with the use of ECMO and the associated long term neurologic outcomes of patients treated with ECMO.