Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD.
Pediatr Crit Care Med. 2018 Aug;19(8):760-766. doi: 10.1097/PCC.0000000000001612.
The goal of this systematic review of the literature was to summarize neurologic outcomes following neonatal and pediatric extracorporeal membrane oxygenation.
We conducted electronic searches of PubMed, Scopus, Web of Science, CINAHL, Cochrane, and EMBASE.
Inclusion criteria included publication dates 2000-2016, patient ages 0-18 years, and use of standardized measures to evaluate outcomes after extracorporeal membrane oxygenation.
We identified 3,497 unique citations; 60 full-text articles were included in the final review.
Studies evaluated patients with congenital diaphragmatic hernia (7), cardiac disease (8), cardiac arrest (13), and mixed populations (32). Follow-up was conducted at hospital discharge in 10 studies (17%) and at a median of 26 months (interquartile range, 8-61 mo) after extracorporeal membrane oxygenation in 50 studies (83%). We found 55 outcome measures that assessed overall health and function (4), global cognitive ability (7), development (4), motor function (5), adaptive function (2), behavior/mood (6), hearing (2), quality of life (2), school achievement (5), speech and language (6), learning and memory (4), and attention and executive function (8). Overall, 10% to as many as 50% of children scored more than 2 SDS below the population mean on cognitive testing. Behavior problems were identified in 16-46% of children tested, and severe motor impairment was reported in 12% of children. Quality of life of former extracorporeal membrane oxygenation patients evaluated at school age or adolescence ranged from similar to healthy peers, to 31-53% having scores more than 1 SD below the population mean.
This systematic review of the literature suggests that children who have undergone extracorporeal membrane oxygenation suffer from a wide range of disabilities. A meta-analysis was not feasible due to heterogeneity in pathologies, outcome measures, and age at follow-up, underscoring the importance of developing and employing a core set of outcomes measures in future extracorporeal membrane oxygenation studies.
本系统综述的目的是总结新生儿和儿科体外膜肺氧合（ECMO）后的神经系统结局。
我们对 PubMed、Scopus、Web of Science、CINAHL、Cochrane 和 EMBASE 进行了电子检索。
纳入标准包括 2000-2016 年出版日期、患者年龄 0-18 岁、以及使用标准化措施评估 ECMO 后的结局。
我们确定了 3497 条独特的引文；最终综述纳入了 60 篇全文文章。
研究评估了患有先天性膈疝（7）、心脏病（8）、心脏骤停（13）和混合人群（32）的患者。10 项研究在出院时进行了随访（17%），50 项研究（83%）在 ECMO 后中位数 26 个月（四分位距，8-61 mo）进行了随访。我们发现了 55 个评估整体健康和功能（4）、整体认知能力（7）、发育（4）、运动功能（5）、适应功能（2）、行为/情绪（6）、听力（2）、生活质量（2）、学业成绩（5）、言语和语言（6）、学习和记忆（4）以及注意力和执行功能（8）的结局测量指标。总体而言，多达 10%至 50%的儿童在认知测试中得分低于人群平均值 2 个标准差以上。接受测试的儿童中，16-46%存在行为问题，12%的儿童存在严重运动障碍。在接受评估的年龄为学龄或青春期的前 ECMO 患者中，生活质量与健康同龄人相似，31-53%的患者得分低于人群平均值 1 个标准差以上。
本系统综述提示，接受 ECMO 的儿童患有广泛的残疾。由于病理、结局测量指标和随访时的年龄存在异质性，因此无法进行荟萃分析，这突出了在未来的 ECMO 研究中开发和使用核心结局测量指标的重要性。
