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Predictors of Brain Infarction in Pediatric Patients During Extracorporeal Membrane Oxygenation
Riccardo Iacobelli1,2,3, Thomas Fux1,4, Sara Wood Schalling2
1Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
Insights
Brain infarction (BI) occurred in 28% of pediatric patients on extracorporeal membrane oxygenation (ECMO). Venoarterial ECMO and high lactate levels independently predicted BI, which was associated with significantly higher mortality.
Area of Science:
- Pediatric Critical Care Medicine
- Neurology
- Cardiovascular Surgery
Background:
- Brain infarction (BI) is a serious complication of extracorporeal membrane oxygenation (ECMO), leading to high morbidity and mortality in pediatric patients.
- Understanding the incidence and predictors of BI is crucial for improving outcomes in this vulnerable population.
Purpose of the Study:
- To determine the incidence of brain infarction (BI) in pediatric patients undergoing ECMO.
- To identify independent predictors of BI in this patient cohort.
Main Methods:
- Retrospective single-center cohort study of pediatric patients (29 days to <18 years) treated with ECMO from January 2010 to October 2023.
- Primary outcome was BI during ECMO; logistic regression was used to analyze predictors.
Main Results:
- Of 179 patients, 51 (28%) developed BI.
- Independent predictors of BI included venoarterial (VA) ECMO and higher pre-ECMO arterial lactate levels.
- 30-day mortality was significantly higher in patients with BI (67%) compared to those without (15%).
Conclusions:
- Brain infarction is a frequent complication of pediatric ECMO, with a higher incidence than previously reported.
- Venoarterial ECMO and elevated pre-ECMO lactate are key predictors of BI.
- Findings support enhanced neurological monitoring and early brain CT in pediatric ECMO patients, especially those on VA ECMO.
Introduction:
Brain infarction (BI) is a severe complication of extracorporeal membrane oxygenation (ECMO) with high morbidity and mortality. We aimed to determine the incidence of BI and identify predictors in pediatric patients receiving ECMO.
Methods:
We performed a retrospective single-center cohort study including patients aged 29 days to < 18 years who underwent ECMO treatment at a tertiary center between January 2010 and October 2023. The primary outcome was BI during ECMO. Predictors of BI were analyzed using logistic regression.
Results:
Among 179 included patients, BI was diagnosed in 51 (28%). Multivariable logistic regression identified venoarterial (VA) ECMO (OR 3.82, 95% CI 1.45-10.08; p = 0.007) and higher pre-ECMO arterial lactate (per mmol/L increase, OR 1.11, 95% CI 1.02-1.20; p = 0.01) as independent predictors of BI. The 30-day mortality was 67% among patients with BI compared with 15% among those without BI (p < 0.001).
Conclusion:
Brain infarction was more common than in most prior reports and was associated with high short-term mortality. VA ECMO mode, compared with venovenous ECMO, and higher pre-ECMO arterial lactate were independent predictors of BI. These findings support enhanced, standardized neurological monitoring and a liberal early brain CT strategy in pediatric ECMO patients, particularly those supported with VA ECMO.
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