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Patterns of Head Computed Tomography Abnormalities During Pediatric Extracorporeal Membrane Oxygenation and
Kerri L LaRovere1, Frederick W Vonberg2, Sanjay P Prabhu3
1Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
Insights
Pediatric extracorporeal membrane oxygenation (ECMO) patients frequently experience acute brain infarction and hemorrhage on head CT scans. These abnormalities correlate with increased seizures and reduced survival rates.
Area of Science:
- Pediatric Neurology
- Neurocritical Care
- Medical Imaging
Background:
- Acute brain infarction and hemorrhage are significant concerns in pediatric patients undergoing extracorporeal membrane oxygenation (ECMO).
- Understanding the patterns and distribution of these neurological complications is crucial for patient management.
Purpose of the Study:
- To classify the type and distribution of acute infarction and hemorrhage detected by head computed tomography (CT) in pediatric ECMO patients.
- To analyze the occurrence of seizures via electroencephalography (EEG) and patient outcomes in relation to CT findings.
Main Methods:
- A single-center observational study reviewed medical records of 179 pediatric patients who underwent ECMO between 2009 and 2013.
- Head CT scans and continuous electroencephalography monitoring were analyzed for neurological abnormalities and seizure activity.
Main Results:
- 46% of ECMO patients had head CT scans, with 60% showing acute pathology (infarction in 55%, hemorrhage in 41%).
- Middle cerebral artery territory infarction was predominant, occurring bilaterally in 41%. Head ultrasound showed 100% sensitivity but only 53% specificity for infarction.
- Electrographic seizures increased in patients with infarction (OR 6.81), and survival was reduced with both infarction (OR 0.22) and hemorrhage (OR 0.31).
Conclusions:
- Head ultrasound is inadequate for ruling out cerebral infarction in pediatric ECMO patients.
- Middle cerebral artery infarction is common and associated with a higher risk of electrographic seizures and poorer outcomes.
Background:
We sought to classify type and distribution of acute infarction and hemorrhage on head computed tomography (CT) during pediatric extracorporeal membrane oxygenation (ECMO). We also analyzed the occurrence of seizures on electroencephalography and outcomes between those with and without CT abnormalities.
Methods:
We conducted a single center observational study in pediatric intensive care units. The medical records of 179 children who underwent ECMO between 2009 and 2013 were reviewed. No interventions were done.
Results:
A total of 46% (82/179) of children underwent CT. Of these, 60% (49/82) had acute pathology. Cerebral infarction occurred in 55% (27/49) and hemorrhage in 41% (20/49). Infarction was arterial in 67% (18/27) with a preponderance in the middle cerebral artery territory (17 patients). Infarction was bilateral in 41% (11/27) and not specific to the side of cannulation in the rest. Sensitivity and specificity for head ultrasound in predicting infarction on CT were 100% and 53%, respectively. A total of 36% (65/179) underwent continuous encephalography monitoring; 22% (14/65) of these had electrographic seizures. Electrographic seizures were increased in those with infarction (odds ratio [OR], 6.81; 95% confidence interval [CI], 1.98 to 23.43). Survival was reduced with both infarction (OR, 0.22; 95% CI, 0.09 to 0.54) and hemorrhage (OR, 0.31; 95% CI, 0.13 to 0.72). Children with CT abnormalities had more unfavorable outcomes (P = 0.01).
Conclusions:
Head ultrasound is insufficient to rule out infarction. Infarction is middle cerebral artery predominant and associated with an increased risk of electrographic seizures.
