(1584) Neurologic and Functional Outcomes of Pediatric Survivors of VA ECMO Cannulated for Sepsis

Monday, February 24, 2025

9:00am – 10:00am Eastern Time

Location: Connections Central - RST 08

First Author(s)

Hirva Chudgar, MD (she/her/hers)

University of Oklahoma
Oklahoma City, Oklahoma, USA

Co-Author(s)

Manzilat Akande, MD, MPH, MS (she/her/hers)

Associate Professor of Pediatrics
University of Oklahoma College of Medicine
Oklahoma City, Oklahoma, United States
Stephanie Brown, MBBS, MS (she/her/hers)

Children's Healthcare of Atlanta/Emory University, USA
XL

Xiaolan Liao, PhD

Assistant Professor of Developmental and Behavioral Pediatrics
University of Oklahoma Health Sciences Center, United States
CA

Christine Allen, MD

Associate Professor of Pediatrics
Section of Critical Care, Department of Pediatrics, University of Oklahoma Health Sciences Center, United States

Introduction: There is a growing number of pediatric patients who receive veno-arterial (VA) ECMO for sepsis and these patients experience high mortality rates of 40-50%. There is evidence that flows as high as 150 mL/kg/min are associated with survival, however the impact on morbidity among survivors remains unknown. Currently, there is little evidence on functional and neurologic prognosis of survivors. Our objective was to identify clinical features associated with favorable neurologic and functional outcomes in pediatric patients receiving VA ECMO for sepsis.

Methods: Multicenter retrospective cohort study of pediatric ECMO data in the Pediatric ECMO Outcomes Registry (PEDECOR,) a national collaborative of ten children’s hospitals. All patients ≤ 18 years of age who received VA ECMO for sepsis between 2011-2023 were included. Neonates and those who received cardiopulmonary bypass during admission were excluded. The primary outcome was favorable neurologic outcome, defined as pediatric cerebral performance category (PCPC) ≤ 2 or unchanged from baseline. Secondary outcome was favorable functional outcome, defined as change of pediatric overall performance category (POPC) or function status score (FSS) ≤ 2. The association between covariates (demographic, clinical, and ECMO support variables) and outcomes was evaluated.

Results: A total of 150 patients met inclusion criteria, sixty-one survived to PICU discharge (41%). Median time from intubation to cannulation was 10 hours (IQR 6-20) and the median peak lactate prior to cannulation was 5 mmol/L (IQR 3-14). The median peak ECMO flow for those with a favorable neurologic outcome was 126 (IQR 101-169) mL/kg/min and for those with a favorable functional outcome 138 (IQR 102-184) mL/kg/min. Data for primary and secondary outcomes was available in 41 (67%) and 48 (79%) survivors, respectively. 31(76%) survivors had a favorable neurologic outcome, and 31 (65%) survivors had a favorable functional outcome. In univariate and multivariate analysis, there was no statistically significant association between variables and outcomes.

Conclusions: Among pediatric survivors of VA ECMO for sepsis, we found high rates of favorable neurologic and functional outcomes. Further work is needed to identify clinical features associated with favorable outcomes.