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Electrographic Seizures in Children and Neonates Undergoing Extracorporeal Membrane Oxygenation
Jainn-Jim Lin1, Brenda L Banwell, Robert A Berg
11Division of Pediatric Critical Care and Pediatric Neurocritical Care, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan. 2Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan. 3Departments of Neurology and Pediatrics, The Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. 4Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. 5Department of Pediatrics, The Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Insights
Electrographic seizures affect 18% of neonates and children on extracorporeal membrane oxygenation (ECMO), often presenting as electrographic-only seizures. Low cardiac output syndrome increases seizure risk, which is linked to poor outcomes and higher mortality.
Area of Science:
- Pediatric Neurology
- Critical Care Medicine
- Neonatology
Background:
- Extracorporeal membrane oxygenation (ECMO) support is critical for neonates and children with severe cardiorespiratory failure.
- Electrographic seizures are a potential complication in critically ill children, but their prevalence and impact in ECMO patients are not well-defined.
Purpose of the Study:
- To determine the prevalence and identify risk factors for electrographic seizures in neonates and children receiving ECMO support.
- To investigate the association between electrographic seizures and clinical outcomes in this vulnerable population.
Main Methods:
- Prospective quality improvement project conducted over two years (July 2013-June 2015) at a quaternary care pediatric institution.
- Clinically indicated electroencephalographic (EEG) monitoring was performed in neonates and children requiring ECMO, adhering to American Clinical Neurophysiology Society guidelines.
- Analysis of 112 patients to evaluate electrographic seizure prevalence, risk factors, and outcomes.
Main Results:
- Electrographic seizures were detected in 18% (18/112) of patients undergoing ECMO.
- Electrographic seizures were more prevalent in patients experiencing low cardiac output syndrome (p=0.03).
- Patients with electrographic seizures had significantly higher mortality (72% vs. 30%; p=0.01) and unfavorable outcomes (54% vs. 17%; p=0.004) compared to those without seizures.
Conclusions:
- Electrographic seizures are common in ECMO patients, frequently manifesting as electrographic-only seizures or electrographic status epilepticus, underscoring the need for EEG monitoring.
- Low cardiac output syndrome is a significant risk factor for developing electrographic seizures in this cohort.
- The presence of electrographic seizures is associated with adverse outcomes, including increased mortality, highlighting the importance of further research into their management.
Objective:
We aimed to determine the prevalence and risk factors for electrographic seizures in neonates and children requiring extracorporeal membrane oxygenation support.
Design:
Prospective quality improvement project.
Setting:
Quaternary care pediatric institution.
Patients:
Consistent with American Clinical Neurophysiology Society electroencephalographic monitoring recommendations, neonates and children requiring extracorporeal membrane oxygenation support underwent clinically indicated electroencephalographic monitoring.
Interventions:
We performed a 2-year quality improvement study from July 2013 to June 2015 evaluating electrographic seizure prevalence and risk factors.
Main Results:
Ninety-nine of 112 patients (88%) requiring extracorporeal membrane oxygenation support underwent electroencephalographic monitoring. Electrographic seizures occurred in 18 patients (18%), of whom 11 patients (61%) had electrographic status epilepticus and 15 patients (83%) had exclusively electrographic-only seizures. Electrographic seizures were more common in patients with low cardiac output syndrome (p = 0.03). Patients with electrographic seizures were more likely to die prior to discharge (72% vs 30%; p = 0.01) and have unfavorable outcomes (54% vs 17%; p = 0.004) than those without electrographic seizures.
Conclusions:
Electrographic seizures occurred in 18% of neonates and children requiring extracorporeal membrane oxygenation support, often constituted electrographic status epilepticus, and were often electrographic-only thereby requiring electroencephalographic monitoring for identification. Low cardiac output syndrome was associated with an increased risk for electrographic seizures. Electrographic seizures were associated with higher mortality and unfavorable outcomes. Further investigation is needed to determine whether electrographic seizures identification and management improves outcomes.
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