Paediatric survivors of extracorporeal life support functional outcomes at one-year follow-up

Objective: To investigate functional outcomes in children who survived extracorporeal life support at 12 months follow-up post-discharge.

Background: Some patients who require extracorporeal life support acquire significant morbidity during their hospitalisation. The Functional Status Scale is a validated tool that allows quantification of paediatric function.

Methods: A retrospective study that included children placed on extracorporeal life support at a quaternary children's hospital between March 2020 and October 2021 and had follow-up encounter within 12 months post-discharge.

Results: Forty-two patients met inclusion criteria: 33% female, 93% veno-arterial extracorporeal membrane oxygenation (VA ECMO), and 12% with single ventricle anatomy. Median age was 1.7 years (interquartile range 10 days-11.9 years). Median hospital stay was 51 days (interquartile range 34-91 days), and median extracorporeal life support duration was 94 hours (interquartile range 56-142 hours). The median Functional Status Scale at discharge was 8.0 (interquartile range 6.3-8.8). The mean change in Functional Status Scale from discharge to follow-up at 9 months (n = 37) was -0.8 [95% confidence interval (CI) -1.3 to -0.4, p < 0.001] and at 12 months (n = 34) was -1 (95% confidence interval -1.5 to -0.4, p < 0.001); the most improvement was in the feeding score. New morbidity (Functional Status Scale increase of ≥3) occurred in 10 children (24%) from admission to discharge. Children with new morbidity were more likely to be younger (p = 0.01), have an underlying genetic syndrome (p = 0.02), and demonstrate evidence of neurologic injury by electroencephalogram or imaging (p = 0.05).

Conclusions: In survivors of extracorporeal life support, the Functional Status Scale improved from discharge to 12-month follow-up, with the most improvement demonstrated in the feeding score.