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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.
Insights
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.
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.
Abstract:
Neurologic complications associated with extracorporeal life support (ECLS), including seizures, ischemia/infarction, and intracranial hemorrhage significantly increase morbidity and mortality in pediatric and neonatal patients. Prompt recognition of adverse neurologic events may provide a window to intervene with neuroprotective measures. Many neuromonitoring modalities are available with varying benefits and limitations. Several pre-ECLS and ECLS-related factors have been associated with an increased risk for neurologic complications. These may be patient- or circuit-related and include modifiable and non-modifiable factors. ECLS survivors are at risk for long-term neurological sequelae affecting neurodevelopmental outcomes. Possible long-term outcomes range from normal development to severe impairment. Patients should undergo a neurological evaluation prior to discharge, and neurodevelopmental assessments should be included in each patient's structured, multidisciplinary follow-up. Safe pediatric and neonatal ECLS management requires a thorough understanding of neurological complications, neuromonitoring techniques and limitations, considerations to minimize risk, and an awareness of possible long-term ramifications. With a focus on ECLS for respiratory failure, this manuscript provides a review of these topics and summarizes best practice guidelines from international organizations and expert consensus.
