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Pediatric ECLS Neurologic Management and Outcomes.

Kylie Callier1, Goeto Dantes2, Kevin Johnson3

  • 1Department of Surgery, The University of Chicago Medicine, Chicago, IL, USA.

Seminars in Pediatric Surgery
|November 9, 2023
PubMed
Summary

Neurologic complications during extracorporeal life support (ECLS) increase risks for pediatric and neonatal patients. Early detection and management are crucial for improving outcomes and minimizing long-term neurodevelopmental effects.

Keywords:
ECLS ECLSManagementNeonatalNeurologicalOutcomesPediatric

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Area of Science:

  • Pediatric critical care medicine
  • Neurocritical care
  • Extracorporeal life support (ECLS)

Background:

  • Neurologic complications, including seizures, ischemia, and hemorrhage, significantly elevate morbidity and mortality in pediatric and neonatal patients undergoing ECLS.
  • Prompt recognition of these neurologic events is vital for timely neuroprotective interventions.
  • ECLS survivors face risks of long-term neurological sequelae impacting neurodevelopmental outcomes, ranging from normal development to severe impairment.

Approach:

  • This review synthesizes current knowledge on neurologic complications associated with ECLS, focusing on respiratory failure.
  • It examines various neuromonitoring modalities, their benefits, and limitations.
  • The manuscript discusses pre-ECLS and ECLS-related risk factors, encompassing both modifiable and non-modifiable patient- and circuit-related factors.

Key Points:

  • Understanding neurologic complications, neuromonitoring techniques, risk mitigation strategies, and long-term sequelae is essential for safe pediatric and neonatal ECLS.
  • Neurologic evaluation before discharge and structured neurodevelopmental assessments in follow-up are recommended for ECLS survivors.
  • Best practice guidelines from international organizations and expert consensus are summarized.

Conclusions:

  • Optimizing pediatric and neonatal ECLS requires a comprehensive approach to managing neurologic complications.
  • Multidisciplinary follow-up care is critical for monitoring and supporting the neurodevelopmental trajectory of ECLS survivors.
  • Adherence to evidence-based guidelines can improve neuroprotection and long-term outcomes in ECLS patients.