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

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
Keyword	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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