Extra-corporeal membrane oxygenation (ECMO) is a life-saving procedure for patients in respiratory or cardiac distress. Prior studies have demonstrated several known risks to the procedure, such as hypoxia, stroke, and other neurological complications (Cheng et al., 2014) that can lead to temporary or permanent deficits in motor abilities, developmental trajectory, academic abilities, and cognition (Glass et al., 1995). Although several studies have investigated morbidity and mortality rates of pediatric ECMO patients, few have looked at cognitive deficits, and even fewer at magnetic resonance imaging in relation to neuropsychological outcome and behavioral, emotional, or social functioning. The aims of this study were to investigate cognitive ability and behavioral functioning in a group of ECMO-treated patients compared to a normative sample, and to examine brain morphometry in hippocampal regions as they relate to cognitive outcome. Participants for this study were recruited from Primary Children's Hospital in Salt Lake City, UT. The total number of participants recruited was 8 (63% female; M age at testing = 16.75, SD = 4.5), and all participants were at least 1 year post-ECMO procedure (M=5.6 years; SD=2.1) for acute respiratory or cardiac illness. Neuropsychological testing was completed using the NIH Toolbox Cognition Battery. Scores were compared to normative data for age to investigate potential impairment in multiple cognitive domains. Each participant and the parent or guardian of minor participants completed brief questionnaires measuring executive functioning, behavior, and social skills, namely The Behavior Rating Inventory of Executive Functioning, The Behavioral Assessment System for Children, Second Edition, and the Social Skills Improvement System Rating Scales. Six of the participants also underwent MR imaging to obtain measures of cortical thickness in the frontal areas of the brain, as well as hippocampal and total intracranial volume. Performance results on the NIH Toolbox Cognition Battery was impaired in over half of the tested individuals who underwent ECMO as children. Attention, executive function, processing speed, and visual memory were well below the expected range for age in the majority of participants. Crystallized intelligence tasks, such as vocabulary, were in the average to above average range for most participants, likely indicating normal baseline functioning. Self- and informant report revealed variable results across participants, with various behavioral, emotional, and social difficulties reported in the group. Bilateral hippocampal volume was positively correlated with scores on tasks of episodic and working memory, though further study with a larger sample and control group is warranted. Preliminary MRI data for cortical thickness and volume of frontal regions are presented. Interpretation of results, limitations, and future directions are discussed.
College and Department
Family, Home, and Social Sciences; Psychology
BYU ScholarsArchive Citation
Thompson, Juliann, "Cognition and Behavioral Outcome in Children and Adolescents with Previous ECMO Treatment: A Case Series with Neuroimaging Correlates" (2018). Theses and Dissertations. 6919.
ECMO, children, pediatric, cortical thickness, executive functioning, NIH Toolbox