Functional assessment in children undergoing extracorporeal membrane oxygenation using the functional status scale: a scoping review

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.