Understanding the impact of ECMO on long-term cognitive and physical functioning amongst Single Ventricle patients who underwent Stage 1 Palliation. Public

Abstract

Title: Understanding the impact of ECMO on long-term cognitive and physical functioning amongst Single Ventricle patients who underwent Stage 1 Palliation

Background: Univentricular patients are at increased risk of mortality. Of these, patients who undergo extracorporeal membrane oxygenation are at higher risk of neurological complications. We aim to describe the short-term outcomes and long-term behavioral outcomes of univentricular patients that required ECMO in the immediate postoperative period after stage I palliation. 

Methods: Single-center retrospective study with a prospective limb at an academic quaternary children’s hospital. All patients who underwent stage I palliation between January/2010 – December/2017 were included and stratified into ECMO and non-ECMO groups. Patient characteristics and Functional Status Scores were collected. BRIEF-II assessment was performed for the enrolled patients. Analysis was performed using appropriate statistics with a significance level set at p = 0.05.

Results: in the study period, we had a cohort of 200 patients. Among those, 50 (25 %) required ECMO postoperatively. Of those, 34% survived to discharge, and 8 (47%, p <0.001) had neurological complications. Among the enrolled cohort, ECMO patients had prolonged hospital length of stay (57 [49; 79.2] p=0.05), prolonged CICU length of stay (42 [23.8;49.2] p<0.05), and neurological complications 62.5% p <0.001 when compared to non-ECMO patients. 25 % of ECMO patients had unfavorable outcomes based on FSS.

There is an increase in T scores in Global Executive Functioning, Emotional regulation, and Behavioral regulation among the ECMO group (p <0.05). 

 Conclusion: Univentricular patients who require ECMO postoperatively are more likely to have challenges in executive functioning, emotional regulation, behavioral control, behavioral awareness, and behavioral tendencies when compared to non-ECMO patients. 

Table of Contents

Introduction....................................................................................................................................8

Aims………….…........................................................................................................................ 11

Subject Group............................................................................................................................... 12

Methods…………......................................................................................................................... 12 

Data analysis…..……................................................................................................................... 21

Results ………..…........................................................................................................................22

Discussion………......................................................................................................................... 37

Conclusion………........................................................................................................................ 39

References ………........................................................................................................................40

Appendix…...……........................................................................................................................ 44

            

Tables and Figures

Figure 1……….……………………………………….……………………………………23

Table 1……….……………………………………….…………………………………… 24

Table 2 ……….……………………………………….……………………………………26

Table 3……….……………………………………….…………………………………… 27

Table 4 ……….……………………………………….……………………………………28

Figure 2……….……………………………………….…………………………………… 29

Figure 3……….……………………………………….…………………………………… 31 

Table 5 ……….……………………………………….……………………………………32

Table 6……….……………………………………….…………………………………… 32

Table 7……….……………………………………….…………………………………… 33

Table 8 ……….……………………………………….……………………………………34

Table 9 ……….……………………………………….……………………………………35

Table 10……….……………………………………….…………………………………...36

About this Honors Thesis

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School	Emory College
Department	Neuroscience and Behavioral Biology
Degree	B.S.
Submission	Honors Thesis
Language	English
Research Field	Psychology, Clinical Psychology, Behavioral Sciences Health Sciences, Human Development
Mot-clé	Neonatal Behavior Functional outcomes Executive Functioning ECMO ADHD Single Ventricle Defect Pediatric Congenital Heart Disease Hypoplastic Left Heart Syndrome (HLHS)
Committee Chair / Thesis Advisor	Dr.Alaa Aljiffry, Emory University
Committee Members	Dr. J. Alex Grizzell, Emory University Dr. Elaine F. Walker, Emory University Dr.Brad Hawley, Emory University

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