Seizures in Children with Cardiac Disease on Extracorporeal Membrane Oxygenation

Hassumani, Daniel; Shan, Mu; Mastropietro, Christopher W.; Wing, Sarah E; Friedman, Matthew L

doi:10.1007/s12028-021-01276-3

Cited by 8 publications

(18 citation statements)

References 25 publications

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“…There was no significant increase in hospital stay in the EEG seizures group compared to the no EEG seizures group [weighted mean difference (WMD) = 4.2 days; 95%CI: –2.499 to 10.931; P = 0.218] ( 16 , 17 ). Meanwhile, no statistical significance was detected in the EEG seizures group after ECMO (WMD: 3.301 days; 95%CI: –20.072 to 26.673; p = 0.782) ( 6 , 18 ) in pediatric. However, a dramatic increase was observed in the group of EEG seizures after CPB as compared with the no EEG seizures group (WMD = 8.8 days; 95%CI: 1.3–16.385; P = 0.022) in pediatric ( 19 – 22 ).…”

Section: Resultsmentioning

confidence: 91%

“…However, accumulating evidence has shown that the use of continuous cardiopulmonary bypass (CPB) is not entirely safe, and may be associated with central nervous system injury and adverse developmental sequelae, studies reported that adult neurocognitive declined dramatically after CPB ( 2 ). Furthermore, the use of CPB or extracorporeal membrane oxygenation (ECMO) carries an inherent risk of complications and may lead to neurological decline ( 3 – 6 ), such as ischemic and hemorrhagic stroke and seizures, which are associated with prolonged hospital stays and increased risk of poor outcome ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Resultsmentioning

confidence: 91%

Section: Introductionmentioning

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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“…Thus, many of these patients are placed on continuous EEG monitoring, particularly during their immediate post-cannulation period. The incidence of seizures in these patients on EEG has been found to range from 18% to 23% [ 7 , 32 , 40 , 41 ]. The veno-arterial (VA) modality has a more significant risk for seizures than veno-venous (VV) ECMO, given the higher risk of thromboembolism, creating a structural epileptic focus [ 40 ].…”

Section: Seizure Presence Duration and Burdenmentioning

confidence: 99%

The Role of Electroencephalography in the Prognostication of Clinical Outcomes in Critically Ill Children: A Review

2022

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Electroencephalography (EEG) is a neurologic monitoring modality that allows for the identification of seizures and the understanding of cerebral function. Not only can EEG data provide real-time information about a patient’s clinical status, but providers are increasingly using these results to understand short and long-term prognosis in critical illnesses. Adult studies have explored these associations for many years, and now the focus has turned to applying these concepts to the pediatric literature. The aim of this review is to characterize how EEG can be utilized clinically in pediatric intensive care settings and to highlight the current data available to understand EEG features in association with functional outcomes in children after critical illness. In the evaluation of seizures and seizure burden in children, there is abundant data to suggest that the presence of status epilepticus during illness is associated with poorer outcomes and a higher risk of mortality. There is also emerging evidence indicating that poorly organized EEG backgrounds, lack of normal sleep features and lack of electrographic reactivity to clinical exams portend worse outcomes in this population. Prognostication in pediatric critical illness must be informed by the comprehensive evaluation of a patient’s clinical status but the utilization of EEG may help contribute to this assessment in a meaningful way.

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“…6 Another recently published cohort of 110 pediatric ECMO patients was found to have an 18% incidence of seizure, with a trend towards increased survival to discharge in patients without seizure. 7 Long-term neurodevelopmental impairment among survivors of pediatric ECMO has also been described in multiple studies. ECMO survivors tend to have poorer performance on neuropsychological testing and decreased ability in specific performance domains such as motor and language relative to their age matched, non-ECMO counterparts when assessed in early childhood and young school age.…”

Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Neurologic Complications of Extracorporeal Cardiopulmonary Resuscitation in Neonates and Infants

Schmaedick

Midura

Gerall

et al. 2022

Child Neurology Open

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Objective: Extracorporeal membrane oxygenation (ECMO) is a lifesaving measure for patients in cardiac or respiratory failure. Extracorporeal cardiopulmonary resuscitation (ECPR) is emergent ECMO cannulation during cardiac arrest. All ECMO patients are at high risk for neurologic complications, but the degree of risk of ECPR relative to ECMO without CPR in progress (non-ECPR ECMO) is not well documented in infants. The goal of the present study is to compare neurologic complication rates between infants who underwent ECPR and those who underwent non-ECPR ECMO. Methods: We performed a retrospective chart review on all patients admitted between 2009 and 2020 to the neonatal intensive care unit (NICU) in our quaternary children's hospital. We separated patients by ECPR vs. non-ECPR ECMO cannulation. We compared rates of death and used neuroimaging and video electroencephalogram (vEEG) to determine incidence of stroke, intracranial hemorrhage, and seizure. Chi-square and Fisher's exact tests were used to compare these categorical variables among groups.Results: A total of 181 infants were cannulated onto ECMO. Of these, 40 received ECPR, 56 received non-ECPR ECMO for a cardiac indication, and 85 received non-ECPR ECMO for a respiratory indication. After excluding patients currently admitted (n=1, ECPR), 180 patients were subjected to analysis. ECPR patients were less likely to survive to hospital discharge than patients who underwent non-ECPR ECMO for respiratory indications, and less likely to survive without any neurologic complication compared with infants who underwent non-ECPR ECMO for cardiac or respiratory indications. Interpretation: Significantly fewer ECPR patients survived without experiencing a neurologic complication, compared with non-ECPR ECMO patients.

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Seizures in Children with Cardiac Disease on Extracorporeal Membrane Oxygenation

Cited by 8 publications

References 25 publications

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

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

The Role of Electroencephalography in the Prognostication of Clinical Outcomes in Critically Ill Children: A Review

Neurologic Complications of Extracorporeal Cardiopulmonary Resuscitation in Neonates and Infants

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