Seizures Are Associated With Brain Injury in Infants Undergoing Extracorporeal Membrane Oxygenation

Huang, Sarah L. Bauer; Said, Ahmed; Smyser, Christopher D.; Lin, John C.; Guilliams, Kristin P.; Guerriero, Réjean M.

doi:10.1177/0883073820966917

Cited by 14 publications

(14 citation statements)

References 40 publications

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“…Electroencephalogram (EEG) is an important tool for neurological assessment. Early monitoring of EEG is necessary during ECMO, especially after ECMO initiation to 48 h after extubation, when the degree of abnormalities and the severity of the neuroimaging findings are clearly correlated and seem to predict the neurological outcome ( 40 , 41 ). Electroconvulsive features were reported to be found on the EEG of the ipsilateral side of children on ECMO with unilateral arterial cannulation, which seemed to illustrate the association of abnormal cerebral hemodynamic changes and impairments of neurological function ( 42 ).…”

Section: Evaluation Of the Nervous System After Reconstruction Or Lig...mentioning

confidence: 99%

ECMO in neonates: The association between cerebral hemodynamics with neurological function

Mao

et al. 2022

Front. Pediatr.

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Extracorporeal membrane oxygenation (ECMO) is a superior life support technology, commonly employed in critical patients with severe respiratory or hemodynamic failure to provide effective respiratory and circulatory support, which is especially recommended for the treatment of critical neonates. However, the vascular management of neonates with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is still under controversy. Reconstruction or ligation for the right common carotid artery (RCCA) after ECMO is inconclusive. This review summarized the existed studies on hemodynamics and neurological function after vascular ligation or reconstruction hoping to provide better strategies for vessel management in newborns after ECMO. After reconstruction, the right cerebral blood flow can increase immediately, and the normal blood supply can be restored rapidly. But the reconstructed vessel may be occluded and stenotic in long-term follow-ups. Ligation may cause lateralization damage, but there could be no significant effect owing to the establishment of collateral circulation. The completion of the circle of Willis, the congenital anomalies of cerebral or cervical vasculature, the duration of ECMO, and the vascular condition at the site of arterial catheterization should be assessed carefully before making the decision. It is also necessary to follow up on the reconstructed vessel sustainability, and the association between cerebral hemodynamics and neurological function requires further large-scale multi-center studies.

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Section: Evaluation Of the Nervous System After Reconstruction Or Lig...mentioning

confidence: 99%

ECMO in neonates: The association between cerebral hemodynamics with neurological function

Mao

et al. 2022

Front. Pediatr.

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“…There was no significant increase in hospital stay in the EEG seizures group compared to the no EEG seizures group [weighted mean difference (WMD) = 4.2 days; 95%CI: –2.499 to 10.931; P = 0.218] ( 16 , 17 ). Meanwhile, no statistical significance was detected in the EEG seizures group after ECMO (WMD: 3.301 days; 95%CI: –20.072 to 26.673; p = 0.782) ( 6 , 18 ) in pediatric. However, a dramatic increase was observed in the group of EEG seizures after CPB as compared with the no EEG seizures group (WMD = 8.8 days; 95%CI: 1.3–16.385; P = 0.022) in pediatric ( 19 – 22 ).…”

Section: Resultsmentioning

confidence: 91%

Incidence, risk factors, and outcomes in electroencephalographic seizures after mechanical circulatory support: A systematic review and meta-analysis

Shen

Hong

et al. 2022

Front. Cardiovasc. Med.

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PurposeTo estimate the overall incidence, risk factors, and clinical outcomes of electroencephalographic (EEG) seizures for adults and children after mechanical circulatory support (MCS).Method and measurementsThis systematic review and meta-analysis were carried out in accordance with the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidance document. MEDLINE EMBASE and CENTRAL were investigated for relevant studies. The related information was retrieved by two independent reviewers and all analyses were conducted by STATA (version 16.0; Stata Corporation, College Station, TX, United States).ResultSixty studies including 36,191 adult and 55,475 pediatric patients with MCS were enrolled for evaluation. The study showed that the overall incidence of EEG seizures in adults was 2% (95%CI: 1–3%), in which 1% (95%CI: 1–2%) after cardiopulmonary bypass (CPB), and 3% (95%CI: 1–6%) after extracorporeal membrane oxygenation (ECMO). For pediatrics patients, the incidence of EEG seizures was 12% (95%CI: 11–14%), among which 12% (9–15%) after CPB and 13% (11–15%) after ECMO. The major risk factors of EEG seizures after MCS in adults were redo surgery (coefficient = 0.0436, p = 0.044), and COPD (coefficient = 0.0749, p = 0.069). In addition, the gestational week of CPB (coefficient = 0.0544, p = 0.080) and respiratory failure of ECMO (coefficient = –0.262, p = 0.019) were also indicated to be associated with EEG seizures in pediatrics.ConclusionEEG seizures after MCS were more common in pediatrics than in adults. In addition, the incidence of EEG seizure after ECMO was higher than CPB both in adults and children. It is expected that appropriate measures should be taken to control modifiable risk factors, thus improving the prognosis and increasing the long-term survival rate of MCS patients.Systematic Review Registration[https://www.crd.york.ac.uk/prospero], identifier [CRD42021287288].

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“…There was significant variation among children’s hospitals in the application of EEG with increasing use observed during the study period. This increase in use may reflect increasing awareness of seizures in children supported by ECMO and practice change toward more proactive neuromonitoring [ 3 , 6 , 27 , 28 ]. There did not seem to be a connection in our data between the rate of EEG use at a hospital and the diagnosis of seizures or use of antiseizure medication.…”

Section: Discussionmentioning

confidence: 99%

“…A recent prospective multicenter observational study reported an incidence of 4% and 16% for ischemic and hemorrhagic neurologic complications of children on ECMO, respectively [2]. Also, single-center studies have demonstrated seizures in 17-40% of ECMO patients, many of which were only detectable on electroencephalography (EEG) [3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Variation in electroencephalography and neuroimaging for children receiving extracorporeal membrane oxygenation

et al. 2023

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Background Seizures, strokes, and intracranial hemorrhage are common and feared complications in children receiving extracorporeal membrane oxygenation (ECMO) support. Researchers and clinicians have proposed and deployed methods for monitoring and detecting neurologic injury, but best practices are unknown. We sought to characterize clinicians’ approach to electroencephalography (EEG) and brain imaging modalities in children supported by ECMO. Methods We performed a retrospective observational cohort study among US Children’s Hospitals participating in the Pediatric Health Information System (PHIS) from 2016 to 2021. We identified hospitalizations containing ECMO support. We stratified these admissions by pediatric, neonatal, cardiac surgery, and non-cardiac surgery. We characterized the frequency of EEG, cranial ultrasound, brain computed tomography (CT), magnetic resonance imaging (MRI), and transcranial Doppler during ECMO hospitalizations. We reported key diagnoses (stroke and seizures) and the prescription of antiseizure medication. To assess hospital variation, we created multilevel logistic regression models. Results We identified 8746 ECMO hospitalizations. Nearly all children under 1 year of age (5389/5582) received a cranial ultrasound. Sixty-two percent of the cohort received an EEG, and use increased from 2016 to 2021 (52–72% of hospitalizations). There was marked variation between hospitals in rates of EEG use. Rates of antiseizure medication use (37% of hospitalizations) and seizure diagnoses (20% of hospitalizations) were similar across hospitals, including high and low EEG utilization hospitals. Overall, 37% of the cohort received a CT and 36% received an MRI (46% of neonatal patients). Stroke diagnoses (16% of hospitalizations) were similar between high- and low-MRI utilization hospitals (15% vs 17%, respectively). Transcranial Doppler (TCD) was performed in just 8% of hospitalizations, and 77% of the patients who received a TCD were cared for at one of five centers. Conclusions In this cohort of children at high risk of neurologic injury, there was significant variation in the approach to EEG and neuroimaging in children on ECMO. Despite the variation in monitoring and imaging, diagnoses of seizures and strokes were similar across hospitals. Future work needs to identify a management strategy that appropriately screens and monitors this high-risk population without overuse of resource-intensive modalities.

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Seizures Are Associated With Brain Injury in Infants Undergoing Extracorporeal Membrane Oxygenation

Cited by 14 publications

References 40 publications

ECMO in neonates: The association between cerebral hemodynamics with neurological function

ECMO in neonates: The association between cerebral hemodynamics with neurological function

Incidence, risk factors, and outcomes in electroencephalographic seizures after mechanical circulatory support: A systematic review and meta-analysis

Variation in electroencephalography and neuroimaging for children receiving extracorporeal membrane oxygenation

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