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Published on: October 24, 2018
Neurological complications of extracorporeal membrane oxygenation in children
Shawn L Hervey-Jumper1, Gail M Annich, Andrea R Yancon
1Department of Neurosurgery, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, Michigan 48109-5338, USA.
Insights
Extracorporeal membrane oxygenation (ECMO) can cause serious neurological complications like intracranial hemorrhage in children. While risky, neurosurgery may benefit select pediatric ECMO patients with hemorrhage.
Area of Science:
- Pediatric critical care medicine
- Pediatric neurosurgery
- Extracorporeal Life Support Organization (ELSO) registry analysis
Background:
- Neurological complications significantly impact outcomes for pediatric patients requiring extracorporeal membrane oxygenation (ECMO) for cardiorespiratory failure.
- Understanding the incidence of these complications and the role of neurosurgery is crucial for improving patient care.
Observation:
- Analysis of the ELSO Registry (1990-2009) revealed intracranial hemorrhage in 7.4% of pediatric ECMO patients, with higher rates in neonates and cardiac cases.
- Cerebral infarction occurred in 5.7% and seizures in 8.4% of pediatric ECMO patients.
- A single institution's registry identified 3 pediatric ECMO patients treated with craniotomy for intracranial hemorrhage, with 2 showing excellent long-term recovery.
Findings:
- Intracranial hemorrhage is a significant neurological complication in pediatric ECMO patients.
- While neurosurgical intervention carries risks, it may be a viable option for carefully selected pediatric patients experiencing intracranial hemorrhage during ECMO.
- Long-term follow-up of surgically treated patients suggests potential for good neurological outcomes.
Implications:
- This study highlights the importance of vigilant neurological monitoring in pediatric ECMO patients.
- It suggests a potential therapeutic role for neurosurgery in managing intracranial hemorrhage in this vulnerable population.
- Further research into patient selection criteria and surgical techniques could optimize outcomes for pediatric ECMO patients with neurological complications.
Object:
Extracorporeal membrane oxygenation (ECMO) is a potentially life-saving treatment for patients in refractory cardiorespiratory failure. Neurological complications that result from ECMO treatment are known to significantly impact patient survival and quality of life. The purpose of this study was to review the incidence of neurological complications of ECMO in the pediatric population and the role of neurosurgery in the treatment of these patients.
Methods:
Data were obtained from the national Extracorporeal Life Support Organization (ELSO) Registry for the years 1990 to 2009. The neurological complications recorded by the registry include CNS hemorrhage, CNS infarction, and seizure. The ECMO Registry at the authors' institution was then searched, and 3 pediatric patients who had undergone craniotomy during ECMO treatment were identified.
Results:
Children in the ELSO Registry who were treated with ECMO survived to hospital discharge in 65% of cases. Intracranial hemorrhage occurred in 7.4% of the ECMO-treated patients, with 36% of those surviving to hospital discharge. Hemorrhage was more likely in patients younger than 30 days old and in those requiring ECMO for cardiac indications. Cerebral infarction occurred in 5.7% of all ECMO-treated patients. Clinically diagnosed seizures occurred in 8.4% of all ECMO-treated patients. The ECMO Registry at the authors' institution revealed that 1898 patients were treated there. Intracranial hemorrhage was diagnosed in 81 patients (5.8%), and 3 of these patients were treated with craniotomy. Two of the patients were alive with minimal neurological impairment and normal school performance at 10 and 16 years of follow-up.
Conclusions:
Intracranial hemorrhage is a serious complication of ECMO treatment. While the surgical risk is substantial, there may be a role for surgical evacuation of hemorrhage in well-selected patients.
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