Electrographic Seizures and Brain Injury in Children Requiring Extracorporeal Membrane Oxygenation

Cook, Robin J.; Rau, Stephanie; Lester-Pelham, Shannon G.; Vesper, Timothy; Peterson, Yuki; Adamowski, Therese; Sturza, Julie; Silverstein, Faye S.; Shellhaas, Renée A.

doi:10.1016/j.pediatrneurol.2020.03.001

Cited by 21 publications

(32 citation statements)

References 23 publications

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“…The PHIS database allows for an evaluation of practices across 47 children's hospitals, has checks for reliability and validity, and has previously been used in pediatric critical care and ECMO research [25,26]. The rates of stroke and seizure diagnoses seen in this cohort are consistent with the rates described in clinical research studies [2][3][4], supporting the accuracy of the diagnosis codes used.…”

Section: Discussionsupporting

confidence: 57%

“…There was significant variation among children’s hospitals in the application of EEG with increasing use observed during the study period. This increase in use may reflect increasing awareness of seizures in children supported by ECMO and practice change toward more proactive neuromonitoring [ 3 , 6 , 27 , 28 ]. There did not seem to be a connection in our data between the rate of EEG use at a hospital and the diagnosis of seizures or use of antiseizure medication.…”

Section: Discussionmentioning

confidence: 99%

“…A recent prospective multicenter observational study reported an incidence of 4% and 16% for ischemic and hemorrhagic neurologic complications of children on ECMO, respectively [2]. Also, single-center studies have demonstrated seizures in 17-40% of ECMO patients, many of which were only detectable on electroencephalography (EEG) [3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

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Variation in electroencephalography and neuroimaging for children receiving extracorporeal membrane oxygenation

et al. 2023

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Background Seizures, strokes, and intracranial hemorrhage are common and feared complications in children receiving extracorporeal membrane oxygenation (ECMO) support. Researchers and clinicians have proposed and deployed methods for monitoring and detecting neurologic injury, but best practices are unknown. We sought to characterize clinicians’ approach to electroencephalography (EEG) and brain imaging modalities in children supported by ECMO. Methods We performed a retrospective observational cohort study among US Children’s Hospitals participating in the Pediatric Health Information System (PHIS) from 2016 to 2021. We identified hospitalizations containing ECMO support. We stratified these admissions by pediatric, neonatal, cardiac surgery, and non-cardiac surgery. We characterized the frequency of EEG, cranial ultrasound, brain computed tomography (CT), magnetic resonance imaging (MRI), and transcranial Doppler during ECMO hospitalizations. We reported key diagnoses (stroke and seizures) and the prescription of antiseizure medication. To assess hospital variation, we created multilevel logistic regression models. Results We identified 8746 ECMO hospitalizations. Nearly all children under 1 year of age (5389/5582) received a cranial ultrasound. Sixty-two percent of the cohort received an EEG, and use increased from 2016 to 2021 (52–72% of hospitalizations). There was marked variation between hospitals in rates of EEG use. Rates of antiseizure medication use (37% of hospitalizations) and seizure diagnoses (20% of hospitalizations) were similar across hospitals, including high and low EEG utilization hospitals. Overall, 37% of the cohort received a CT and 36% received an MRI (46% of neonatal patients). Stroke diagnoses (16% of hospitalizations) were similar between high- and low-MRI utilization hospitals (15% vs 17%, respectively). Transcranial Doppler (TCD) was performed in just 8% of hospitalizations, and 77% of the patients who received a TCD were cared for at one of five centers. Conclusions In this cohort of children at high risk of neurologic injury, there was significant variation in the approach to EEG and neuroimaging in children on ECMO. Despite the variation in monitoring and imaging, diagnoses of seizures and strokes were similar across hospitals. Future work needs to identify a management strategy that appropriately screens and monitors this high-risk population without overuse of resource-intensive modalities.

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Section: Discussionsupporting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Variation in electroencephalography and neuroimaging for children receiving extracorporeal membrane oxygenation

et al. 2023

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“…The severity of EEG abnormalities during ECMO that corresponded with severity of neuroimaging abnormalities has been partly supported in recent studies where seizures during EEG were linked to brain hemorrhage and brain injury [2,16,17]. A prior study where only a combination of HUS and EEG was highly predictive of abnormal neuroimaging findings may be secondary to the use of routine EEG, as opposed to LTM, lack of scoring system for neuroimaging abnormalities, and proximity of neuroimaging to the ECMO run [18].…”

Section: Discussionmentioning

confidence: 93%

EEG is A Predictor of Neuroimaging Abnormalities in Pediatric Extracorporeal Membrane Oxygenation

Fox

Jenks

Farhat

et al. 2020

JCM

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The goal of this project was to evaluate if severity of electroencephalogram (EEG) during or shortly after being placed on extracorporeal membrane oxygenation (ECMO) would correlate with neuroimaging abnormalities, and if that could be used as an early indicator of neurologic injury. This was a retrospective chart review spanning November 2009 to May 2018. Patients who had an EEG recording during ECMO or within 48 hours after being decannulated (early group) or within 3 months of being on ECMO (late group) were included if they also had ECMO-related neuroimaging. In the early EEG group, severity of the EEG findings of mild, moderate, and severe EEG correlated to mild, moderate, and severe neuroimaging scores. Patients on venoarterial (VA) ECMO were noted to have higher EEG and neuroimaging severity; this was statistically significant. There was no association in the late EEG group to neuroimaging abnormalities. Our study highlights that EEG severity can be an early predictor for neuroimaging abnormalities that can be identified by computed tomography (CT) and or magnetic resonance imaging (MRI). This can provide guidance for both the medical team and families, allowing for a better understanding of overall prognosis.

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“…The incidence of seizures was correlated with higher mortality and unfavorable neurodevelopmental outcomes ( 33 ). Therefore, great importance should be attached to the application of non-invasive monitoring ( 34 ), EEG, featuring with prompt detection of seizures for all patients with MCS ( 35 ).…”

Section: Discussionmentioning

confidence: 99%

Incidence, risk factors, and outcomes in electroencephalographic seizures after mechanical circulatory support: A systematic review and meta-analysis

Shen

Hong

et al. 2022

Front. Cardiovasc. Med.

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PurposeTo estimate the overall incidence, risk factors, and clinical outcomes of electroencephalographic (EEG) seizures for adults and children after mechanical circulatory support (MCS).Method and measurementsThis systematic review and meta-analysis were carried out in accordance with the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidance document. MEDLINE EMBASE and CENTRAL were investigated for relevant studies. The related information was retrieved by two independent reviewers and all analyses were conducted by STATA (version 16.0; Stata Corporation, College Station, TX, United States).ResultSixty studies including 36,191 adult and 55,475 pediatric patients with MCS were enrolled for evaluation. The study showed that the overall incidence of EEG seizures in adults was 2% (95%CI: 1–3%), in which 1% (95%CI: 1–2%) after cardiopulmonary bypass (CPB), and 3% (95%CI: 1–6%) after extracorporeal membrane oxygenation (ECMO). For pediatrics patients, the incidence of EEG seizures was 12% (95%CI: 11–14%), among which 12% (9–15%) after CPB and 13% (11–15%) after ECMO. The major risk factors of EEG seizures after MCS in adults were redo surgery (coefficient = 0.0436, p = 0.044), and COPD (coefficient = 0.0749, p = 0.069). In addition, the gestational week of CPB (coefficient = 0.0544, p = 0.080) and respiratory failure of ECMO (coefficient = –0.262, p = 0.019) were also indicated to be associated with EEG seizures in pediatrics.ConclusionEEG seizures after MCS were more common in pediatrics than in adults. In addition, the incidence of EEG seizure after ECMO was higher than CPB both in adults and children. It is expected that appropriate measures should be taken to control modifiable risk factors, thus improving the prognosis and increasing the long-term survival rate of MCS patients.Systematic Review Registration[https://www.crd.york.ac.uk/prospero], identifier [CRD42021287288].

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Electrographic Seizures and Brain Injury in Children Requiring Extracorporeal Membrane Oxygenation

Cited by 21 publications

References 23 publications

Variation in electroencephalography and neuroimaging for children receiving extracorporeal membrane oxygenation

Variation in electroencephalography and neuroimaging for children receiving extracorporeal membrane oxygenation

EEG is A Predictor of Neuroimaging Abnormalities in Pediatric Extracorporeal Membrane Oxygenation

Incidence, risk factors, and outcomes in electroencephalographic seizures after mechanical circulatory support: A systematic review and meta-analysis

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