Utility of serial EEGs in neonates during extracorporeal membrane oxygenation

We found electroencephalographic (EEG) studies to be useful for monitoring cerebral function, for confirming seizure activity, and for limited prediction of short-term outcome in 145 neonates who required extra-corporeal membrane oxygenation (ECMO) of reversible respiratory failure. The EEG tracings were classified as normal or as mildly, moderately, or markedly abnormal; abnormal recordings were further classified as focal, diffuse, or predominantly lateralized. A significant decrease in frequency and degree of EEG abnormalities was observed in recordings obtained after ECMO compared to those obtained prior to (P = .001) or during ECMO (P = .001). There was no significant increase in marked EEG abnormalities when recordings obtained before and during ECMO were compared (P = 0.41). Of 11 infants with electrographic seizures during ECMO, 7 (64%) either died during their nursery courses or were developmentally handicapped at age 1 year which is a significantly greater adverse outcome than that observed in infants without EEG seizure activity (P less than .003). No consistently lateralized EEG abnormalities were observed during or after ECMO when compared to tracings obtained before cannulation of the right common carotid artery. There was no acute change in EEG rhythm or amplitude over the right cerebral hemisphere during right common carotid artery cannulation. Our observations support the value of serial EEG in the assessment of cerebral function in critically ill infants undergoing ECMO. They further suggest that, in this patient population, cannulation of the right common carotid artery is a safe procedure that does not result in lateralized abnormalities of cerebral electrical activity.