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Functional Status Scale identifies mild to moderate impairment in children on ECMO supportNew data shows functional outcomes for children on ECMO machines

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Key Takeaway
Note that the FSS identifies mild to moderate functional impairment in children on ECMO, primarily in feeding and respiration.

This scoping review synthesized 25 publications to evaluate the use of the Functional Status Scale (FSS) for assessing functional outcomes in children aged 0 to 18 years undergoing Extracorporeal Membrane Oxygenation (ECMO). The review highlights the FSS as a tool for characterizing rehabilitation needs in this population.

Findings indicate that survivors of ECMO typically experience mild to moderate functional impairment. Specific impairments were noted primarily in feeding and respiratory functions. While some survivors showed improvement, the review notes that the FSS may not detect certain neurobehavioral abnormalities that can coexist with normal scores.

Several limitations were identified, including the absence of studies formally evaluating the metric properties of the FSS specifically in the pediatric ECMO population. Additionally, only 8 studies included measurements taken after discharge or discontinuation of support. The authors suggest that while the FSS is a useful tool for identifying rehabilitation needs, more prospective studies with standardized procedures and longitudinal measurements are required to improve clinical utility.

When a child needs an ECMO machine, it is a critical moment for their survival. But survival is just the first step. Doctors and parents need to know what life looks like after the machine is turned off. A review of 25 publications looked at how children aged 0 to 18 years performed after using this life-saving support.

The review found that children who survived often had mild to moderate functional impairments. These issues were most common in areas like feeding and respiratory function. While some survivors showed improvement over time, the data shows that these physical challenges are common hurdles in the recovery process.

One important note for families is that the standard tool used to measure these results, called the Functional Status Scale, might not catch every single issue. Specifically, it may not pick up certain behavior or brain-related changes. Because of these gaps, more research is needed to fully understand how these children recover.

What this means for you:
Children surviving on ECMO often face mild to moderate issues with breathing and eating during their recovery.

Common questions

What kind of physical challenges do children face after using ECMO?

Children who survived using ECMO machines often showed mild to moderate functional impairments. These issues were most common in areas related to feeding and respiratory function. While some survivors showed improvement, these physical challenges are common parts of the recovery process after being on life support.

Is the Functional Status Scale a reliable way to measure recovery?

The Functional Status Scale is a common tool used to see what a child needs during rehabilitation. However, it has limits. It may not detect certain neurobehavioral abnormalities, and no study has formally tested how well the scale works specifically for this group of children.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedSep 2026
View Original Abstract ↓
As interest in the long-term outcomes of Extracorporeal Membrane Oxygenation (ECMO) grows, the Functional Status Scale (FSS) has emerged as an important tool for characterising rehabilitation needs in this patient population. This scoping review aimed to synthesise the functional outcomes assessed using the FSS, describe changes in these outcomes from baseline through discharge and during follow-up, examine the methodologies used to assign and interpret scores, and identify the main limitations and gaps in knowledge. The review was conducted according to the JBI methodology and the PRISMA-ScR guidelines, with the protocol registered in OSF (DOI: 10.17605/OSF.IO/AW287). We searched MEDLINE/PubMed, Ovid Emcare, and Scopus for studies of patients aged 0–18 years who underwent ECMO. We included 25 publications, predominantly retrospective cohorts from U.S. centres, with heterogeneous populations, indications, and ECMO modalities. The FSS primarily assessed functional status at discharge and new morbidity compared with baseline. Survivors generally exhibited mild to moderate functional impairment, primarily in feeding and respiratory function. Eight studies included measurements taken after discharge or discontinuation of support and described improvement in some survivors; however, a normal FSS score could coexist with neurobehavioral abnormalities the scale did not detect. No study formally evaluated the metric properties of the FSS specifically in this population. Prospective studies with standardised procedures, longitudinal measurements, and complementary assessments of neurodevelopment, adaptive behaviour, and quality of life are needed. Furthermore, qualitative studies could broaden our understanding of the post-ECMO experience by exploring the perspectives of patients and their families, changes in family dynamics, care and rehabilitation needs, and the influence of the social, educational, and community environment on the recovery process.Systematic Review Registrationhttps://osf.io/aw287/overview.
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