Predictors of mortality and neurological morbidity in children undergoing extracorporeal life support for cardiac disease

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. (C) 2004 Elsevier B.V. All rights reserved.