Neurologic complications and neurodevelopmental outcome with extracorporeal life support

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.