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Published on: August 19, 2020
Neurologic outcome in children after extracorporeal membrane oxygenation: prognostic value of diagnostic tests
Angela Amigoni1, Andrea Pettenazzo, Paolo Biban
1Department of Paediatrics, University of Padua, Via Giustiniani 3, 35128 Padua, Italy.
Insights
Long-term neurologic outcomes for neonates and children surviving extracorporeal membrane oxygenation (ECMO) show persistent negative results. Electroencephalogram, neuroimaging, and somatosensory evoked potentials predict poor neurologic outcomes in these vulnerable populations.
Area of Science:
- Pediatric Intensive Care
- Neurology
- Neonatal Medicine
Background:
- Extracorporeal membrane oxygenation (ECMO) is a life-support measure for critically ill neonates and children.
- Long-term neurodevelopmental outcomes after ECMO are not fully understood.
- Identifying prognostic indicators is crucial for patient management and counseling.
Purpose of the Study:
- To evaluate the 36-month neurologic outcome in neonates and children after ECMO.
- To identify prognostic indicators of neurologic outcome following ECMO treatment.
Main Methods:
- Prospective study in a pediatric intensive care unit.
- Involved 12 neonates and 9 children surviving ECMO.
- Assessed neurologic outcomes using neurodevelopmental tests, evoked potentials (auditory, visual, somatosensory), electroencephalogram, and neuroimaging at multiple time points (6, 12, 24, 36 months).
- Analyzed pre- and during-ECMO clinical variables.
Main Results:
- Negative neurologic outcomes were observed in 8.3% of neonates and 30% of children at 12 months post-ECMO, with no significant changes at 24 or 36 months.
- Abnormal electroencephalogram (especially the first and most abnormal during ECMO), neuroimaging scores, and somatosensory evoked potentials were associated with negative outcomes.
- Pre-ECMO oxygenation index and pH, and during-ECMO pH, oxygen partial pressure, and bypass duration were also analyzed.
Conclusions:
- Neonates and children treated with ECMO require long-term neurologic follow-up.
- Electroencephalogram, neuroimaging, and somatosensory evoked potentials are valuable prognostic indicators for adverse neurologic outcomes after ECMO.
- Early identification of at-risk patients can guide therapeutic strategies and support.
Abstract:
This report presents the long-term (36 months) neurologic outcome in 12 neonates and 9 children who survived after extracorporeal membrane oxygenation and attempts to identify its prognostic indicators through a prospective study in the pediatric intensive care unit of a university hospital. Outcome assessment, neurodevelopmental tests, electroencephalogram, auditory evoked potentials, visual evoked potentials, and somatosensory evoked potentials, cerebral sonography, or cerebral tomography were evaluated at the end of bypass and at 6, 12, 24, and 36 months after extracorporeal membrane oxygenation. "Before extracorporeal membrane oxygenation" variables (oxygenation index, pH, oxygen arterial partial pressure) and "during extracorporeal membrane oxygenation" variables (pH, oxygen arterial partial pressure, duration of bypass, clotting activated time, electroencephalogram) were also analyzed. A negative neurologic outcome (Glasgow Outcome Score different from "good recovery" or neurodevelopmental score less than 70) 12 months after extracorporeal membrane oxygenation was documented in 8.3% of neonates and in 30% of children who survived. There was no further change in subsequent evaluations (24 and 36 months follow-up). The most abnormal electroencephalogram during extracorporeal membrane oxygenation, the first electroencephalogram, neuroimaging score, and somatosensory evoked potentials after extracorporeal membrane oxygenation treatment were associated with negative neurologic outcome. The study documented that neonates and children treated with extracorporeal membrane oxygenation require long-term follow-up; electroencephalogram, neuroimaging score, and somatosensory evoked potentials have prognostic value for abnormal neurologic outcome.
