Patterns of Head Computed Tomography Abnormalities During Pediatric Extracorporeal Membrane Oxygenation and Association With Outcomes

LaRovere, Kerri L.; Vonberg, Frederick W.; Prabhu, Sanjay P.; Kapur, Kush; Harini, Chellamani; Garcia-Jacques, Rogelio; Chao, Jessica; Akhondi-Asl, Aliresa; Thiagarajan, Ravi R.; Tasker, Robert C.

doi:10.1016/j.pediatrneurol.2017.05.006

Cited by 23 publications

(16 citation statements)

References 28 publications

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“…27 Specifically, pediatric patients with ischemic stroke, intraparenchymal hemorrhage, or venous thrombosis are at particularly high risk for seizures, ranging from 19% to 44%. 13 Patients on extracorporeal membrane oxygenation are also at high risk for these neurologic injuries, including, ischemic, hemorrhagic, or venous infarction, 4,28,29 with head ultrasonography identified as an insufficient screening tool for infarction. 28 Lin and colleagues 16 also showed 71% of patients with electrographic seizures in their extracorporeal membrane oxygenation cohort had acute imaging findings.…”

Section: Discussionmentioning

confidence: 99%

“…13 Patients on extracorporeal membrane oxygenation are also at high risk for these neurologic injuries, including, ischemic, hemorrhagic, or venous infarction, 4,28,29 with head ultrasonography identified as an insufficient screening tool for infarction. 28 Lin and colleagues 16 also showed 71% of patients with electrographic seizures in their extracorporeal membrane oxygenation cohort had acute imaging findings. Thus, by screening for seizures (a common indication for patients on extracorporeal membrane oxygenation), EEG may also be a reasonable, noninvasive, serial monitor for neurologic injury, particularly in young patients with congenital heart disease.…”

Section: Discussionmentioning

confidence: 99%

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Seizures Are Associated With Brain Injury in Infants Undergoing Extracorporeal Membrane Oxygenation

et al. 2020

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Objective: Determine seizure frequency and association with neurologic outcomes in infants undergoing extracorporeal membrane oxygenation. Identify patient or clinical factors associated with seizures or brain injury on imaging. Methods: Retrospective, single-center study including infants less than 1 year of age, who underwent extracorporeal membrane oxygenation between 2012 and 2017. Results: A total of 104 infants met study criteria including 45 patients with continuous electroencephalographic (EEG) monitoring during their extracorporeal membrane oxygenation run and 59 infants without EEG. Seizures (electrographic-only or electro-clinical) were identified in 18 of the 45 (40%). Among the 18 infants with seizures, 14 (78%) had moderate to severe brain injury, whereas only 44% of those without seizures (12 of 27) on EEG had moderate to severe brain injury ( P = .03). Cardiopulmonary resuscitation prior to extracorporeal membrane oxygenation (ECPR), mode of extracorporeal membrane oxygenation, length of stay, survival to discharge, and congenital heart disease were not associated with seizures. One of 10 patients with cyanotic congenital heart disease due to hypoplastic left heart syndrome had seizures compared with 7 of 10 patients with non–hypoplastic left heart syndrome lesions ( P = .02). Seizures were associated with moderate to severe brain injury, after adjusting for ECPR and congenital heart disease ( P = .04). Conclusions: Electrographic seizures were common in patients undergoing extracorporeal membrane oxygenation and higher than previously reported. Seizures were associated with moderate to severe abnormalities on imaging, after adjusting for ECPR and congenital heart disease. This study adds to recent literature describing the risk of seizures in patients on extracorporeal membrane oxygenation and highlights the presence of brain injuries that may be identified by routine EEG surveillance.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Seizures Are Associated With Brain Injury in Infants Undergoing Extracorporeal Membrane Oxygenation

et al. 2020

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“…There are, of course, limitations to cranial US, with the diagnostic quality of cranial US being highly operator-dependent and with reduced visualisation of the posterior fossa and convexity regions. Furthermore, ultrasound has reduced sensitivity and specificity for pathologies other than major haemorrhage compared to both CT and MRI [3][4][5][6].…”

Section: Relevance Of Cranial Ultrasound In Extracorporeal Membrane Omentioning

confidence: 99%

Imaging of cerebral complications of extracorporeal membrane oxygenation in infants with congenital heart disease — ultrasound with multimodality correlation

et al. 2020

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Cranial ultrasound on neonatal intensive care units is generally performed by intensive care physicians, but radiologists often provide this crucial bedside test to children on specialist paediatric cardiac intensive care units. On a paediatric cardiac intensive care unit, complex congenital cardiac conditions are commonly encountered in both pre-and postoperative scenarios, often with the use of extracorporeal membrane oxygenation (ECMO), which both increases the risks of a number of neurologic complications and results in significant changes in vascular physiology. The aim of this pictorial essay is to discuss cranial ultrasound technique, demonstrate the changes in Doppler flow profiles resulting from veno-arterial extracorporeal membrane oxygenation and congenital cardiac conditions, and illustrate commonly encountered intracranial complications of extracorporeal membrane oxygenation support in congenital cardiac care.

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“…A single center pediatric study found that majority of strokes were bilateral, a few were unilateral right sided lesions and no patients had unilateral left sided strokes; majority of the lesions were in the anterior cerebral circulation distribution [22]. Ischemic lesions are associated with electrographic seizures and decreased survival [38]. Asymmetry in regional cerebral saturation or on continuous EEG monitoring might be suggestive of focal ischemia.…”

Section: Ischemic Complicationsmentioning

confidence: 99%

Neurologic Complications and Neuromonitoring on ECMO

Pinto¹

2019

Advances in Extracorporeal Membrane Oxygenation - Volume 3

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Extracorporeal membrane oxygenation is challenged by several potential complications. Adverse neurologic events such as intracranial hemorrhages, strokes, seizures, and brain death are among the most detrimental and even catastrophic of ECMO complications. There are several risk factors related to the patients, their underlying conditions and the therapy itself that predispose these patients to neurologic injuries. In this chapter, we review different types of neurological complications, the identification and management of which can be difficult. We will also discuss some of the currently available technologies for multimodal neurological monitoring as a complement to clinical exam.

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Patterns of Head Computed Tomography Abnormalities During Pediatric Extracorporeal Membrane Oxygenation and Association With Outcomes

Cited by 23 publications

References 28 publications

Seizures Are Associated With Brain Injury in Infants Undergoing Extracorporeal Membrane Oxygenation

Seizures Are Associated With Brain Injury in Infants Undergoing Extracorporeal Membrane Oxygenation

Imaging of cerebral complications of extracorporeal membrane oxygenation in infants with congenital heart disease — ultrasound with multimodality correlation

Neurologic Complications and Neuromonitoring on ECMO

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