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Published on: May 16, 2015
Neurophysiologic Features Reflecting Brain Injury During Pediatric ECMO Support
Damla Hanalioglu1, M 'Hamed Temkit1, Kara Hildebrandt1
1Division of Neurology, Department of Neuroscience, Barrow Neurological Institute at Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, AZ, 85016, USA.
Insights
Increased seizure burden and interhemispheric differences in electroencephalography and TCD MCA TIBI scores are key indicators of acute brain injury in children on ECMO support.
Area of Science:
- Pediatric critical care medicine
- Neurocritical care
- Extracorporeal life support
Background:
- Extracorporeal membrane oxygenation (ECMO) is a vital treatment for severe cardiopulmonary failure in children.
- However, ECMO therapy is associated with a significant risk of acute brain injury (ABI).
- Identifying predictors of ABI in pediatric ECMO patients is crucial for timely intervention.
Purpose of the Study:
- To identify clinical and neuromonitoring characteristics associated with acute brain injury in pediatric patients undergoing ECMO.
- To develop a model for predicting the risk of acute brain injury in this vulnerable population.
Main Methods:
- Prospective observational study of pediatric ECMO patients from 2019-2022.
- Utilized continuous electroencephalography (EEG), cerebral oximetry, and transcranial Doppler (TCD) ultrasound for neuromonitoring.
- Multivariate logistic regression and best subset model selection were employed to identify independent predictors of ABI.
Main Results:
- 19 out of 62 (30.6%) pediatric ECMO patients experienced acute brain injury.
- Acute brain injury was associated with increased seizure burden, EEG amplitude interhemispheric differences, and TCD Thrombolysis in Brain Ischemia (TIBI) score interhemispheric differences.
- A predictive model incorporating these factors demonstrated high discriminative ability (AUC=0.92).
Conclusions:
- Increased seizure burden is a significant risk factor for acute brain injury in pediatric ECMO patients.
- Interhemispheric differences in quantitative EEG amplitude and TCD MCA TIBI scores are independently associated with acute brain injury.
- These neuromonitoring parameters can aid in early detection and management of acute brain injury during ECMO support.
Background:
Extracorporeal membrane oxygenation (ECMO) provides lifesaving support to critically ill patients who experience refractory cardiopulmonary failure but carries a high risk for acute brain injury. We aimed to identify characteristics reflecting acute brain injury in children requiring ECMO support.
Methods:
This is a prospective observational study from 2019 to 2022 of pediatric ECMO patients undergoing neuromonitoring, including continuous electroencephalography, cerebral oximetry, and transcranial Doppler ultrasound (TCD). The primary outcome was acute brain injury. Clinical and neuromonitoring characteristics were collected. Multivariate logistic regression was implemented to model odds ratios (ORs) and identify the combined characteristics that best discriminate risk of acute brain injury using the area under the receiver operating characteristic curve.
Results:
Seventy-five pediatric patients requiring ECMO support were enrolled in this study, and 62 underwent neuroimaging or autopsy evaluations. Of these 62 patients, 19 experienced acute brain injury (30.6%), including seven (36.8%) with arterial ischemic stroke, four (21.1%) with hemorrhagic stroke, seven with hypoxic-ischemic brain injury (36.8%), and one (5.3%) with both arterial ischemic stroke and hypoxic-ischemic brain injury. A univariate analysis demonstrated acute brain injury to be associated with maximum hourly seizure burden (p = 0.021), electroencephalographic suppression percentage (p = 0.022), increased interhemispheric differences in electroencephalographic total power (p = 0.023) and amplitude (p = 0.017), and increased differences in TCD Thrombolysis in Brain Ischemia (TIBI) scores between bilateral middle cerebral arteries (p = 0.023). Best subset model selection identified increased seizure burden (OR = 2.07, partial R2 = 0.48, p = 0.013), increased quantitative electroencephalographic interhemispheric amplitude differences (OR = 2.41, partial R2 = 0.48, p = 0.013), and increased interhemispheric TCD TIBI score differences (OR = 4.66, partial R2 = 0.49, p = 0.006) to be independently associated with acute brain injury (area under the receiver operating characteristic curve = 0.92).
Conclusions:
Increased seizure burden and increased interhemispheric differences in both quantitative electroencephalographic amplitude and TCD MCA TIBI scores are independently associated with acute brain injury in children undergoing ECMO support.
