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J Thorac Cardiovasc Surg 2008;136:976-983
© 2008 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Two–year survival, mental, and motor outcomes after cardiac extracorporeal life support at less than five years of age

^a Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
^c School of Public Health, University of Alberta, Edmonton, Alberta, Canada
^e Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
^b Pediatric Rehabilitation Outcomes Evaluation and Research Unit, Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada
^d Department of Pediatric Cardiology, Khon Kaen University, Khon Kaen, Thailand

Received for publication October 26, 2007; revisions received January 20, 2008; accepted for publication February 3, 2008.

^_* Address for reprints: Ari R. Joffe, MD, Department of Pediatrics, 3A3.07 Stollery Children's Hospital, 8440- 112 St, Edmonton, Alberta, Canada, T6G 2B7. (Email: ajoffe{at}cha.ab.ca).

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.