Two–year survival, mental, and motor outcomes after cardiac extracorporeal life support at less than five years of age
Objective Comprehensive outcome assessment of children receiving cardiac extracorporeal life support. Methods From 2000 to 2004, 39 consecutive children (aged 1 day to 4.4 years) had cardiac extracorporeal life support. Neurodevelopmental follow-up of all survivors was performed more than 6 months a...
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| creator | Lequier, Laurance, MD Joffe, Ari R., MD Robertson, Charlene M.T., MD Dinu, Irina A., PhD Wongswadiwat, Yuttapong, MD Anton, Natalie R., MD Ross, David B., MD Rebeyka, Ivan M., MD |
| description | Objective Comprehensive outcome assessment of children receiving cardiac extracorporeal life support. Methods From 2000 to 2004, 39 consecutive children (aged 1 day to 4.4 years) had cardiac extracorporeal life support. Neurodevelopmental follow-up of all survivors was performed more than 6 months after life support (aged 53 ± 12 months). Developmental delay was defined as a score of less than 70 on the Bayley Scales of Infant Development II or Wechsler Preschool and Primary Scale of Intelligence. Predictor variables for mortality (at 2 years' follow-up) and delay were examined by univariate and multivariate analyses. Results Indications for extracorporeal life support were progressive low cardiac output in 14 (36%), failed weaning from cardiopulmonary bypass in 13 (33%), cardiac arrest in 9 (23%), and hypoxia in 3 (8%). Cardiac anatomy was single ventricle in 16 (41%), biventricular in 21 (54%), and myocarditis in 2 (5%). Survival was 18 (46%) at hospital discharge and 16 (41%) at 2 years. In survivors, mental score was 73 ± 16 (normal 100 ± 15), and 8 (50%) had mental delay. Initiating extracorporeal life support during cardiopulmonary resuscitation and duration of this resuscitation were not associated with death or mental delay. On multivariable Cox regression, lactate on admission to the pediatric intensive care unit (hazard rate 1.13; 95% confidence intervals 1.08–1.27) and single ventricle anatomy (hazard rate 3.93; 95% confidence intervals 1.62–9.49) were associated with death at 2 years. Stepwise multiple regression found time for lactate to normalize on extracorporeal life support, highest inotrope score during 120 hours of life support, and chromosomal abnormality explained 76.7% of the variance in mental score. Conclusion Cardiac extracorporeal life support had a 41% 2-year survival. Potentially modifiable variables (time for lactate to normalize and highest inotrope score early during extracorporeal life support) explained 69% of mental score variance. |
| doi_str_mv | 10.1016/j.jtcvs.2008.02.009 |
| format | Article |
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Methods From 2000 to 2004, 39 consecutive children (aged 1 day to 4.4 years) had cardiac extracorporeal life support. Neurodevelopmental follow-up of all survivors was performed more than 6 months after life support (aged 53 ± 12 months). Developmental delay was defined as a score of less than 70 on the Bayley Scales of Infant Development II or Wechsler Preschool and Primary Scale of Intelligence. Predictor variables for mortality (at 2 years' follow-up) and delay were examined by univariate and multivariate analyses. Results Indications for extracorporeal life support were progressive low cardiac output in 14 (36%), failed weaning from cardiopulmonary bypass in 13 (33%), cardiac arrest in 9 (23%), and hypoxia in 3 (8%). Cardiac anatomy was single ventricle in 16 (41%), biventricular in 21 (54%), and myocarditis in 2 (5%). Survival was 18 (46%) at hospital discharge and 16 (41%) at 2 years. In survivors, mental score was 73 ± 16 (normal 100 ± 15), and 8 (50%) had mental delay. Initiating extracorporeal life support during cardiopulmonary resuscitation and duration of this resuscitation were not associated with death or mental delay. On multivariable Cox regression, lactate on admission to the pediatric intensive care unit (hazard rate 1.13; 95% confidence intervals 1.08–1.27) and single ventricle anatomy (hazard rate 3.93; 95% confidence intervals 1.62–9.49) were associated with death at 2 years. Stepwise multiple regression found time for lactate to normalize on extracorporeal life support, highest inotrope score during 120 hours of life support, and chromosomal abnormality explained 76.7% of the variance in mental score. Conclusion Cardiac extracorporeal life support had a 41% 2-year survival. Potentially modifiable variables (time for lactate to normalize and highest inotrope score early during extracorporeal life support) explained 69% of mental score variance.</description><identifier>ISSN: 0022-5223</identifier><identifier>EISSN: 1097-685X</identifier><identifier>DOI: 10.1016/j.jtcvs.2008.02.009</identifier><identifier>PMID: 18954639</identifier><identifier>CODEN: JTCSAQ</identifier><language>eng</language><publisher>Philadelphia, PA: Mosby, Inc</publisher><subject>Age Factors ; Analysis of Variance ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Cardiac Surgical Procedures - methods ; Cardiac Surgical Procedures - mortality ; Cardiology. Vascular system ; Cardiopulmonary Bypass - adverse effects ; Cardiopulmonary Bypass - methods ; Cardiopulmonary Resuscitation - methods ; Cardiopulmonary Resuscitation - mortality ; Cardiothoracic Surgery ; Cause of Death ; Child, Preschool ; Cohort Studies ; Confidence Intervals ; Developmental Disabilities - epidemiology ; Developmental Disabilities - etiology ; Extracorporeal Membrane Oxygenation - methods ; Extracorporeal Membrane Oxygenation - mortality ; Female ; Heart Arrest - mortality ; Heart Arrest - therapy ; Heart Defects, Congenital - diagnosis ; Heart Defects, Congenital - mortality ; Heart Defects, Congenital - surgery ; Humans ; Infant ; Infant, Newborn ; Life Support Care - methods ; Male ; Medical sciences ; Mental Disorders - epidemiology ; Mental Disorders - etiology ; Motor Skills Disorders - epidemiology ; Motor Skills Disorders - etiology ; Multivariate Analysis ; Palliative Care - methods ; Pneumology ; Postoperative Complications - diagnosis ; Postoperative Complications - therapy ; Proportional Hazards Models ; Regression Analysis ; Retrospective Studies ; Sensitivity and Specificity ; Survival Analysis ; Time Factors ; Treatment Outcome</subject><ispartof>The Journal of thoracic and cardiovascular surgery, 2008-10, Vol.136 (4), p.976-983.e3</ispartof><rights>The American Association for Thoracic Surgery</rights><rights>2008 The American Association for Thoracic Surgery</rights><rights>2008 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c585t-74e88b521228e805da85eaf5371e73734b42ccf5d11db0f03e3f703a415813b33</citedby><cites>FETCH-LOGICAL-c585t-74e88b521228e805da85eaf5371e73734b42ccf5d11db0f03e3f703a415813b33</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jtcvs.2008.02.009$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,3548,27923,27924,45994</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20818750$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18954639$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lequier, Laurance, MD</creatorcontrib><creatorcontrib>Joffe, Ari R., MD</creatorcontrib><creatorcontrib>Robertson, Charlene M.T., MD</creatorcontrib><creatorcontrib>Dinu, Irina A., PhD</creatorcontrib><creatorcontrib>Wongswadiwat, Yuttapong, MD</creatorcontrib><creatorcontrib>Anton, Natalie R., MD</creatorcontrib><creatorcontrib>Ross, David B., MD</creatorcontrib><creatorcontrib>Rebeyka, Ivan M., MD</creatorcontrib><creatorcontrib>Western Canadian Complex Pediatric Therapies Program Follow-up Group</creatorcontrib><title>Two–year survival, mental, and motor outcomes after cardiac extracorporeal life support at less than five years of age</title><title>The Journal of thoracic and cardiovascular surgery</title><addtitle>J Thorac Cardiovasc Surg</addtitle><description>Objective Comprehensive outcome assessment of children receiving cardiac extracorporeal life support. Methods From 2000 to 2004, 39 consecutive children (aged 1 day to 4.4 years) had cardiac extracorporeal life support. Neurodevelopmental follow-up of all survivors was performed more than 6 months after life support (aged 53 ± 12 months). Developmental delay was defined as a score of less than 70 on the Bayley Scales of Infant Development II or Wechsler Preschool and Primary Scale of Intelligence. Predictor variables for mortality (at 2 years' follow-up) and delay were examined by univariate and multivariate analyses. Results Indications for extracorporeal life support were progressive low cardiac output in 14 (36%), failed weaning from cardiopulmonary bypass in 13 (33%), cardiac arrest in 9 (23%), and hypoxia in 3 (8%). Cardiac anatomy was single ventricle in 16 (41%), biventricular in 21 (54%), and myocarditis in 2 (5%). Survival was 18 (46%) at hospital discharge and 16 (41%) at 2 years. In survivors, mental score was 73 ± 16 (normal 100 ± 15), and 8 (50%) had mental delay. Initiating extracorporeal life support during cardiopulmonary resuscitation and duration of this resuscitation were not associated with death or mental delay. On multivariable Cox regression, lactate on admission to the pediatric intensive care unit (hazard rate 1.13; 95% confidence intervals 1.08–1.27) and single ventricle anatomy (hazard rate 3.93; 95% confidence intervals 1.62–9.49) were associated with death at 2 years. Stepwise multiple regression found time for lactate to normalize on extracorporeal life support, highest inotrope score during 120 hours of life support, and chromosomal abnormality explained 76.7% of the variance in mental score. Conclusion Cardiac extracorporeal life support had a 41% 2-year survival. Potentially modifiable variables (time for lactate to normalize and highest inotrope score early during extracorporeal life support) explained 69% of mental score variance.</description><subject>Age Factors</subject><subject>Analysis of Variance</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Cardiac Surgical Procedures - methods</subject><subject>Cardiac Surgical Procedures - mortality</subject><subject>Cardiology. Vascular system</subject><subject>Cardiopulmonary Bypass - adverse effects</subject><subject>Cardiopulmonary Bypass - methods</subject><subject>Cardiopulmonary Resuscitation - methods</subject><subject>Cardiopulmonary Resuscitation - mortality</subject><subject>Cardiothoracic Surgery</subject><subject>Cause of Death</subject><subject>Child, Preschool</subject><subject>Cohort Studies</subject><subject>Confidence Intervals</subject><subject>Developmental Disabilities - epidemiology</subject><subject>Developmental Disabilities - etiology</subject><subject>Extracorporeal Membrane Oxygenation - methods</subject><subject>Extracorporeal Membrane Oxygenation - mortality</subject><subject>Female</subject><subject>Heart Arrest - mortality</subject><subject>Heart Arrest - therapy</subject><subject>Heart Defects, Congenital - diagnosis</subject><subject>Heart Defects, Congenital - mortality</subject><subject>Heart Defects, Congenital - surgery</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Life Support Care - methods</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Mental Disorders - epidemiology</subject><subject>Mental Disorders - etiology</subject><subject>Motor Skills Disorders - epidemiology</subject><subject>Motor Skills Disorders - etiology</subject><subject>Multivariate Analysis</subject><subject>Palliative Care - methods</subject><subject>Pneumology</subject><subject>Postoperative Complications - diagnosis</subject><subject>Postoperative Complications - therapy</subject><subject>Proportional Hazards Models</subject><subject>Regression Analysis</subject><subject>Retrospective Studies</subject><subject>Sensitivity and Specificity</subject><subject>Survival Analysis</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0022-5223</issn><issn>1097-685X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFks-KFDEQxhtR3HX1CQTJRb04YyXpdKcPCrL4DxY8uIK3kElXdjKmO7NJenbn5jv4hj6JaWdQ8OKpKPh9XxVfVVU9prCkQJuXm-Umm11aMgC5BLYE6O5UpxS6dtFI8fVudQrA2EIwxk-qByltAKAF2t2vTqjsRN3w7rS6vbwJP7__2KOOJE1x53bavyADjnmueuzJEHKIJEzZhAET0TZjJEbH3mlD8DZHbULchojaE-8sFpttaTPRmXhMieS1Hol1OyTzlESCJfoKH1b3rPYJHx3rWfXl3dvL8w-Li0_vP56_uVgYIUVetDVKuRKMMiZRgui1FKit4C3Flre8XtXMGCt6SvsVWODIbQtc11RIylecn1XPDr7bGK4nTFkNLhn0Xo8YpqSarqXFqCsgP4AmhpQiWrWNbtBxryioOXC1Ub8DV3PgCpgqgRfVk6P9tBqw_6s5JlyAp0dAJ6O9jXo0Lv3hGEgqWwGFe37g1u5qfeMiqjRo74stnccmyhtVq65tCvnqQGKJbecwqmQcjgb7ojJZ9cH9Z-XX_-iNd6Mry33DPaZNmOJYLqKoSkWgPs9fND8RSAAqqeC_AOecxCc</recordid><startdate>20081001</startdate><enddate>20081001</enddate><creator>Lequier, Laurance, MD</creator><creator>Joffe, Ari R., MD</creator><creator>Robertson, Charlene M.T., MD</creator><creator>Dinu, Irina A., PhD</creator><creator>Wongswadiwat, Yuttapong, MD</creator><creator>Anton, Natalie R., MD</creator><creator>Ross, David B., MD</creator><creator>Rebeyka, Ivan M., MD</creator><general>Mosby, Inc</general><general>AATS/WTSA</general><general>Elsevier</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20081001</creationdate><title>Two–year survival, mental, and motor outcomes after cardiac extracorporeal life support at less than five years of age</title><author>Lequier, Laurance, MD ; Joffe, Ari R., MD ; Robertson, Charlene M.T., MD ; Dinu, Irina A., PhD ; Wongswadiwat, Yuttapong, MD ; Anton, Natalie R., MD ; Ross, David B., MD ; Rebeyka, Ivan M., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c585t-74e88b521228e805da85eaf5371e73734b42ccf5d11db0f03e3f703a415813b33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Age Factors</topic><topic>Analysis of Variance</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Cardiac Surgical Procedures - methods</topic><topic>Cardiac Surgical Procedures - mortality</topic><topic>Cardiology. Vascular system</topic><topic>Cardiopulmonary Bypass - adverse effects</topic><topic>Cardiopulmonary Bypass - methods</topic><topic>Cardiopulmonary Resuscitation - methods</topic><topic>Cardiopulmonary Resuscitation - mortality</topic><topic>Cardiothoracic Surgery</topic><topic>Cause of Death</topic><topic>Child, Preschool</topic><topic>Cohort Studies</topic><topic>Confidence Intervals</topic><topic>Developmental Disabilities - epidemiology</topic><topic>Developmental Disabilities - etiology</topic><topic>Extracorporeal Membrane Oxygenation - methods</topic><topic>Extracorporeal Membrane Oxygenation - mortality</topic><topic>Female</topic><topic>Heart Arrest - mortality</topic><topic>Heart Arrest - therapy</topic><topic>Heart Defects, Congenital - diagnosis</topic><topic>Heart Defects, Congenital - mortality</topic><topic>Heart Defects, Congenital - surgery</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Life Support Care - methods</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Mental Disorders - epidemiology</topic><topic>Mental Disorders - etiology</topic><topic>Motor Skills Disorders - epidemiology</topic><topic>Motor Skills Disorders - etiology</topic><topic>Multivariate Analysis</topic><topic>Palliative Care - methods</topic><topic>Pneumology</topic><topic>Postoperative Complications - diagnosis</topic><topic>Postoperative Complications - therapy</topic><topic>Proportional Hazards Models</topic><topic>Regression Analysis</topic><topic>Retrospective Studies</topic><topic>Sensitivity and Specificity</topic><topic>Survival Analysis</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lequier, Laurance, MD</creatorcontrib><creatorcontrib>Joffe, Ari R., MD</creatorcontrib><creatorcontrib>Robertson, Charlene M.T., MD</creatorcontrib><creatorcontrib>Dinu, Irina A., PhD</creatorcontrib><creatorcontrib>Wongswadiwat, Yuttapong, MD</creatorcontrib><creatorcontrib>Anton, Natalie R., MD</creatorcontrib><creatorcontrib>Ross, David B., MD</creatorcontrib><creatorcontrib>Rebeyka, Ivan M., MD</creatorcontrib><creatorcontrib>Western Canadian Complex Pediatric Therapies Program Follow-up Group</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lequier, Laurance, MD</au><au>Joffe, Ari R., MD</au><au>Robertson, Charlene M.T., MD</au><au>Dinu, Irina A., PhD</au><au>Wongswadiwat, Yuttapong, MD</au><au>Anton, Natalie R., MD</au><au>Ross, David B., MD</au><au>Rebeyka, Ivan M., MD</au><aucorp>Western Canadian Complex Pediatric Therapies Program Follow-up Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Two–year survival, mental, and motor outcomes after cardiac extracorporeal life support at less than five years of age</atitle><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle><addtitle>J Thorac Cardiovasc Surg</addtitle><date>2008-10-01</date><risdate>2008</risdate><volume>136</volume><issue>4</issue><spage>976</spage><epage>983.e3</epage><pages>976-983.e3</pages><issn>0022-5223</issn><eissn>1097-685X</eissn><coden>JTCSAQ</coden><abstract>Objective Comprehensive outcome assessment of children receiving cardiac extracorporeal life support. Methods From 2000 to 2004, 39 consecutive children (aged 1 day to 4.4 years) had cardiac extracorporeal life support. Neurodevelopmental follow-up of all survivors was performed more than 6 months after life support (aged 53 ± 12 months). Developmental delay was defined as a score of less than 70 on the Bayley Scales of Infant Development II or Wechsler Preschool and Primary Scale of Intelligence. Predictor variables for mortality (at 2 years' follow-up) and delay were examined by univariate and multivariate analyses. Results Indications for extracorporeal life support were progressive low cardiac output in 14 (36%), failed weaning from cardiopulmonary bypass in 13 (33%), cardiac arrest in 9 (23%), and hypoxia in 3 (8%). Cardiac anatomy was single ventricle in 16 (41%), biventricular in 21 (54%), and myocarditis in 2 (5%). Survival was 18 (46%) at hospital discharge and 16 (41%) at 2 years. In survivors, mental score was 73 ± 16 (normal 100 ± 15), and 8 (50%) had mental delay. Initiating extracorporeal life support during cardiopulmonary resuscitation and duration of this resuscitation were not associated with death or mental delay. On multivariable Cox regression, lactate on admission to the pediatric intensive care unit (hazard rate 1.13; 95% confidence intervals 1.08–1.27) and single ventricle anatomy (hazard rate 3.93; 95% confidence intervals 1.62–9.49) were associated with death at 2 years. Stepwise multiple regression found time for lactate to normalize on extracorporeal life support, highest inotrope score during 120 hours of life support, and chromosomal abnormality explained 76.7% of the variance in mental score. Conclusion Cardiac extracorporeal life support had a 41% 2-year survival. Potentially modifiable variables (time for lactate to normalize and highest inotrope score early during extracorporeal life support) explained 69% of mental score variance.</abstract><cop>Philadelphia, PA</cop><pub>Mosby, Inc</pub><pmid>18954639</pmid><doi>10.1016/j.jtcvs.2008.02.009</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Age Factors Analysis of Variance Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Cardiac Surgical Procedures - methods Cardiac Surgical Procedures - mortality Cardiology. Vascular system Cardiopulmonary Bypass - adverse effects Cardiopulmonary Bypass - methods Cardiopulmonary Resuscitation - methods Cardiopulmonary Resuscitation - mortality Cardiothoracic Surgery Cause of Death Child, Preschool Cohort Studies Confidence Intervals Developmental Disabilities - epidemiology Developmental Disabilities - etiology Extracorporeal Membrane Oxygenation - methods Extracorporeal Membrane Oxygenation - mortality Female Heart Arrest - mortality Heart Arrest - therapy Heart Defects, Congenital - diagnosis Heart Defects, Congenital - mortality Heart Defects, Congenital - surgery Humans Infant Infant, Newborn Life Support Care - methods Male Medical sciences Mental Disorders - epidemiology Mental Disorders - etiology Motor Skills Disorders - epidemiology Motor Skills Disorders - etiology Multivariate Analysis Palliative Care - methods Pneumology Postoperative Complications - diagnosis Postoperative Complications - therapy Proportional Hazards Models Regression Analysis Retrospective Studies Sensitivity and Specificity Survival Analysis Time Factors Treatment Outcome |
| title | Two–year survival, mental, and motor outcomes after cardiac extracorporeal life support at less than five years of age |
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