Introduction: Rates of extracorporeal life support (ECLS) for children with critical illness have doubled in the last decade. This increase has been associated with a significant burden of morbidity amongst ECLS survivors. Our objective was to identify demographic, clinical, and ECLS-related variables associated with favorable neurologic and functional outcomes in pediatric survivors of ECLS. Methods: Multicenter retrospective cohort study utilizing the Pediatric ECMO Outcomes Registry (PEDECOR). Survivors of ECLS aged 30 days to 18 years across 10 years (2015-2024) were included. Neonates and those who received cardiopulmonary bypass were excluded. Favorable neurologic and functional outcomes were defined as a change in Pediatric Cerebral Performance Category (PCPC) score or Functional Status Score (FSS) of ≤2 or unchanged from baseline, respectively. Logistic regression models were used to assess the association between study variables and outcomes. Results: Of 139 included patients, 94% had a favorable neurologic outcome and 66% had a favorable functional outcome. ECLS type was a nearly even distribution between Veno-arterial and Veno-venous (48% vs. 52%). Patients with longer median time to cannulation from intubation, primary diagnosis of infection, autoimmune, or multisystem disorder, age ≤ 2 years, and longer median time in the PICU after decannulation had significantly lower odds of favorable functional outcome in the unadjusted analysis (p< 0.05 for all). In the adjusted models, each additional day of ECLS was associated with 30% lower odds of a favorable functional outcome (p< 0.001). Patients who received ECLS for an infectious or autoimmune indication had 96% lower odds of a favorable functional outcome compared to those who received ECLS for a cardiovascular indication (p=0.012). The effect of ECLS duration on functional outcome was modified by age and history of a neurologic disorder. ECLS type was not significantly associated with functional outcome. No study variables were associated with a favorable neurologic outcome. Conclusions: Among pediatric survivors of ECLS, we observed high rates of favorable neurologic and functional outcomes. Factors independently associated with a worse functional outcome were younger age and indications for ECLS due to infectious or autoimmune conditions.
Chudgar et al. (Sun,) studied this question.