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Delirium in the Pediatric Cardiac Extracorporeal Membrane Oxygenation Patient Population: A Case Series
Anita K Patel1, Katherine V Biagas2, Eunice C Clark3
1Department of Pediatric Critical Care, Children's National Medical Center, Washington, DC.
Insights
All children needing venoarterial extracorporeal membrane oxygenation (ECMO) developed delirium. Routine delirium screening in pediatric ECMO patients is crucial for early detection and improved outcomes.
Area of Science:
- Pediatric Critical Care Medicine
- Neonatal Research
- Cardiothoracic Surgery
Background:
- Delirium is a serious complication in critically ill children.
- Extracorporeal membrane oxygenation (ECMO) is a life-support measure for severe cardiorespiratory failure.
- The prevalence of delirium in pediatric ECMO patients is not well-established.
Purpose of the Study:
- To determine the incidence and prevalence of delirium in children requiring venoarterial extracorporeal membrane oxygenation.
- To assess the impact of delirium on pediatric ECMO patients.
Main Methods:
- Prospective observational longitudinal cohort study in a pediatric cardiothoracic ICU.
- Daily delirium screening using the Cornell Assessment for Pediatric Delirium.
- Analysis of 72 patient days on venoarterial ECMO support.
Main Results:
- All eight pediatric patients requiring venoarterial ECMO developed delirium.
- Delirium was diagnosed on 21% of ECMO days; 65% of days were spent in coma.
- Only 13% of ECMO days were free of both delirium and coma.
Conclusions:
- Delirium is a universal complication in children on venoarterial ECMO.
- Pediatric ECMO patients are at extremely high risk for delirium.
- Routine delirium screening can lead to earlier detection and treatment, potentially improving outcomes.
Objective:
To determine the prevalence of delirium in children who require extracorporeal membrane oxygenation.
Design:
Prospective observational longitudinal cohort study.
Setting:
Urban academic cardiothoracic ICU.
Patients:
All consecutive admissions to the cardiothoracic ICU who required venoarterial extracorporeal membrane oxygenation support.
Interventions:
Daily delirium screening with the Cornell Assessment for Pediatric Delirium.
Measurements And Main Results:
Eight children required extracorporeal membrane oxygenation during the study period, with a median extracorporeal membrane oxygenation duration of 202 hours (interquartile range, 99-302). All eight children developed delirium during their cardiothoracic ICU stay. Seventy-two days on extracorporeal membrane oxygenation were included in the analysis. A majority of patient days on extracorporeal membrane oxygenation were spent in coma (65%). Delirium was diagnosed during 21% of extracorporeal membrane oxygenation days. Only 13% of extracorporeal membrane oxygenation days were categorized as delirium free and coma free. Delirium screening was successfully completed on 70/72 days on extracorporeal membrane oxygenation (97%).
Conclusions:
In this cohort, delirium occurred in all children who required venoarterial extracorporeal membrane oxygenation. It is likely that this patient population has an extremely high risk for delirium and will benefit from routine screening in order to detect and treat delirium sooner. This has potential to improve both short- and long-term outcomes.
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