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Central nervous system complications during pediatric extracorporeal life support: incidence and risk factors

Pelin Cengiz1, Kristy Seidel, Peter T Rycus

  • 1Department of Pediatrics, University of Washington, Seattle, USA.

Critical Care Medicine
|December 15, 2005
PubMed

Insights

Pediatric patients requiring extracorporeal life support (ECLS) face a significant risk of central nervous system (CNS) complications. Pre-existing conditions like metabolic acidosis and use of certain devices increase this risk, necessitating close monitoring.

Area of Science:

  • Pediatric Critical Care Medicine
  • Cardiovascular Surgery
  • Neurology

Background:

  • Acute, severe central nervous system (CNS) complications are a serious concern in pediatric patients undergoing extracorporeal life support (ECLS).
  • Understanding the incidence and risk factors is crucial for improving patient outcomes.

Purpose of the Study:

  • To identify the incidence of acute, severe CNS complications in pediatric patients receiving ECLS.
  • To determine the risk factors associated with the development of these CNS complications.

Main Methods:

  • Retrospective review of the Extracorporeal Life Support Organization (ELSO) registry database.
  • Analysis of data from 4,942 pediatric patients (1 month to 18 years) treated between 1981-2002 across 115 international tertiary centers.

Main Results:

  • 12.9% of patients (636/4,942) developed acute, severe CNS complications.
  • Risk factors identified include: ECLS during extracorporeal cardiopulmonary resuscitation (OR 2.48), pre-ECLS left ventricular assist device use (OR 3.45), bicarbonate administration (OR 1.61), and vasopressor/inotropic medications (OR 1.22).
  • Venoarterial ECLS for pulmonary failure was associated with higher CNS complication rates compared to venovenous ECLS (13.5% vs 5.7%).

Conclusions:

  • Patients with pre-ECLS metabolic acidosis, requirement for bicarbonate or inotropes/vasopressors, cardiopulmonary resuscitation, or a left ventricular assist device are at increased risk.
  • Close monitoring for CNS complications is recommended for patients developing renal failure or metabolic acidosis post-ECLS, or those undergoing venoarterial ECLS.
Abstract

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