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Alpha-Delta Ratio for Detection of Cerebral Injury and Stroke in Pediatric Extracorporeal Membrane Oxygenation
Arnold J Sansevere1,2,3, Melissa L DiBacco1,2,4, Kelly Cavan1,2
1Division of Epilepsy and Neurophysiology, Boston Children's Hospital, Boston, MA, U.S.A.
Insights
The alpha-delta ratio (ADR) can reliably detect cerebral injury and stroke in pediatric patients undergoing extracorporeal membrane oxygenation (ECMO). This biomarker shows significant differences in patients with injury, suggesting its clinical utility.
Area of Science:
- Neuroscience
- Pediatric Critical Care Medicine
- Biomarker Discovery
Background:
- Cerebral injury and stroke are significant concerns in pediatric patients on extracorporeal membrane oxygenation (ECMO).
- Current methods for detecting these complications may have limitations.
- The alpha-delta ratio (ADR) is being investigated as a potential biomarker.
Purpose of the Study:
- To evaluate the alpha-delta ratio (ADR) as a biomarker for detecting cerebral injury and stroke in pediatric ECMO patients.
- To assess the interhemispheric difference in ADR as an indicator of brain injury.
Main Methods:
- Retrospective study of pediatric patients (gestation >44 weeks to 21 years) on ECMO with continuous electroencephalography (cEEG).
- Calculation of the interhemispheric ADR difference per hour.
- Statistical comparison (t-test, ANOVA) of ADR differences between control and injured groups at various time points.
Main Results:
- 49 pediatric patients were included; 45% had cerebrovascular injury, with 82% of those having focal stroke.
- A significant difference in mean interhemispheric ADR was observed between control and injured patients after 6 hours of cEEG (P=0.03).
- Analysis of variance confirmed significant differences in ADR at 24 hours among control, early-acquired, and late-acquired injury groups (P=0.03).
Conclusions:
- The alpha-delta ratio (ADR) demonstrates reliability in detecting in-ECMO cerebral injury and stroke in pediatric patients.
- Further research is warranted to automate ADR assessment for real-time stroke detection during ECMO.
- ADR shows promise as a valuable neurophysiological biomarker in this critical population.
Introduction:
To assess the alpha-delta ratio (ADR) as a biomarker for cerebral injury and stroke in pediatric extracorporeal membrane oxygenation (ECMO).
Methods:
Retrospective study of children aged >44 weeks gestation to 21 years monitored with continuous electroencephalography during ECMO. The interhemispheric ADR difference between the left and right hemisphere was calculated per hour. A t -test was performed comparing the mean interhemispheric difference between controls and patients with cerebral injury at set intervals (i.e., 1, 3, 6, 9, 12, and 24 hours) from the start of continuous electroencephalography. Injury was established if confirmed by imaging on the same day as ECMO cannulation and acquired if confirmed the day after ECMO or later. Analysis of variance was performed to compare the mean interhemispheric difference in the ADR among control patients to those with early-acquired and late-acquired injury at 24 hours.
Results:
We included 49 patients with a median age of 3.4 years (interquartile range [1-10.4]), 47% (23/49) were male, and 73% (36/49) had cardiac arrest. Cerebrovascular injury was detected in 45% (22/49), with focal stroke in 82% (18/22). A significant difference was seen between control patients compared with cerebrovascular injury after 6 hours of continuous electroencephalography (0.016 vs. 0.042) (mean interhemispheric ADR difference) ( P = 0.03). Analysis of variance of control patients to early- and late-acquired injury at 24 hours showed a significant difference ( P = 0.03).
Conclusions:
The ADR is a reliable metric to detect in-ECMO cerebral injury and stroke. Further study is needed to automate and assess this metric for real-time detection of stroke in ECMO.
