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Ann Thorac Surg 2007;84:1356
© 2007 The Society of Thoracic Surgeons
Division of Cardiothoracic Surgery, Emory University School of Medicine, 1405 Clifton Rd, Atlanta, GA 30322
(Email: kkanter{at}emory.edu).
This report from Oslo, Norway [1] reviews 22 consecutive survivors of either cardiac (n = 13) or respiratory (n = 9) extracorporeal membrane oxygenation (ECMO) with careful neurocognitive testing on an average of 6 years after ECMO support. The authors found that 73% of these children had some neurologic impairment. On neurologic motor examination, 45% of the children were categorized as having mild-to-moderate impairment, and 27% exhibited severe impairment, with 5 children having microcephaly. Of the 14 children who underwent magnetic resonance imaging, 8 (57%) had evidence of ischemic injury. A full 50% of these children had an abnormal electroencephalogram and 45% had significant cognitive disability. Despite these depressing figures, it was found that 64% of the parents underestimated the degree of deficits in their children and 54% of the parents believed that their children had minimal or no deficits whatsoever.
These sobering figures remind us that despite what seems to be a brilliant clinical success with advanced technology (ie, extracorporeal membrane oxygenation [ECMO]), the days of looking merely at hospital survival as a marker of success are vanishing. It is clear that these ECMO survivors require formal neurocognitive testing with time recognizing that a majority will have significant clinical impairment that will affect their everyday life negatively. Once this is recognized, these children should be appropriately directed to special schooling or therapeutic intervention as indicated. We can not rely on the parents to recognize these deficits as indicated by this article, because we must resort to objective clinical testing.
Despite our apparent clinical success in the short term, it seems that we have uncovered a new set of problems in children who previously would have never survived to exhibit these problems. Clearly, sobering reports, such as this one in The Annals of Thoracic Surgery, stress the importance of long-term objective follow-up of survivors of many of the seemingly magical surgical feats that we can perform today. Furthermore, follow-up series, such as this one, underscore the importance of examining our current techniques by not only optimizing recovery of the heart and lungs, but also by attempting to protect the brain in the process.
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  E. Waitzer, S.P. Riley, T. Perreault, and M. I. Shevell Neurologic Outcome at School Entry for Newborns Treated With Extracorporeal Membrane Oxygenation for Noncardiac Indications J Child Neurol, July 1, 2009; 24(7): 801 - 806. [Abstract] [PDF]
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