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Updated: Sep 24, 2025
A Thrombotic Stroke Model Based On Transient Cerebral Hypoxia-ischemia
Published on: August 18, 2015
Stroke in pediatric ECMO patients: analysis of the National Inpatient Sample (NIS) database
Chidiebere Ezetendu1, Orkun Baloglu1, Hasan F Othman2
1Department of Pediatric Critical Care, Cleveland Clinic Children's, Cleveland, OH, USA.
Insights
Pediatric stroke during extracorporeal membrane oxygenation (ECMO) is increasing. Hemorrhagic and combined strokes raise mortality, while all strokes lengthen hospital stays for ECMO patients.
Area of Science:
- Pediatric critical care medicine
- Neurology
- Cardiovascular surgery
Background:
- Stroke is a significant complication in pediatric patients undergoing extracorporeal membrane oxygenation (ECMO).
- Inconsistent reporting of stroke rates and outcomes in ECMO patients necessitates further investigation.
Purpose of the Study:
- To compare outcomes of pediatric ECMO patients with and without stroke.
- To describe the frequency trends of stroke in pediatric ECMO patients from 2000 to 2017.
Main Methods:
- Utilized the National Inpatient Sample (NIS) database to identify pediatric patients (age ≤18 years) receiving ECMO.
- Employed ICD-9&10 codes for patient identification.
- Conducted binary, regression, and trend analyses to compare outcomes between stroke and no-stroke groups.
Main Results:
- Identified 28,695 pediatric ECMO patients, with 10.4% experiencing stroke (hemorrhagic, ischemic, or combined).
- Higher mortality was observed in hemorrhagic and combined stroke groups compared to ischemic stroke and no-stroke groups.
- Stroke patients had significantly longer lengths of stay (LOS); hemorrhagic stroke was associated with hypertension and septicemia, while combined stroke correlated with cardiac arrest and seizures.
Conclusions:
- Stroke diagnosis in pediatric ECMO patients shows an increasing trend over time.
- All stroke types are linked to increased LOS in ECMO patients.
- Hemorrhagic and combined strokes are associated with increased mortality, unlike ischemic strokes.
Background:
The rates, outcomes, and long-term trends of stroke complicating the use of extracorporeal membrane oxygenation (ECMO) have been inconsistently reported. We compared the outcomes of pediatric ECMO patients with and without stroke and described the frequency trends between 2000 and 2017.
Methods:
Using the National Inpatient Sample (NIS) database, pediatric patients (age ≤18 years) who received ECMO were identified using ICD-9&10 codes. Binary, regression, and trend analyses were performed to compare patients with and without stroke.
Results:
A total of 114,477,997 records were reviewed. Overall, 28,695 (0.025%) ECMO patients were identified of which 2982 (10.4%) had stroke, which were further classified as hemorrhagic (n = 1464), ischemic (n = 1280), or combined (n = 238). Mortality was higher in the hemorrhagic and combined groups compared to patients with ischemic stroke and patients without stroke. Length of stay (LOS) was significantly longer in stroke vs. no-stroke patients. Hypertension and septicemia were more encountered in the hemorrhagic group, whereas the combined group demonstrated higher frequency of cardiac arrest and seizures.
Conclusions:
Over the years, there is an apparent increase in the diagnosis of stroke. All types of stroke in ECMO patients are associated with increased LOS, although mortality is increased in hemorrhagic and combined stroke only.
Impact:
Stroke is a commonly seen complication in pediatric patients supported by ECMO. Understanding the trends will help in identifying modifiable risk factors that predict poor outcomes in this patient population.
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