Significance of seizures associated with extracorporeal membrane oxygenation

Campbell, Lynn; Bunyapen, Chantrapa; Gangarosa, Maria E.; Cohen, Morris J.; Kanto, William P.

doi:10.1016/s0022-3476(05)80304-x

Cited by 49 publications

(21 citation statements)

References 9 publications

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“…Neonates treated with ECLS who experienced seizures were significantly more likely to experience poor outcome, including death or developmental delay (17,18). Follow-up studies in this population revealed that the occurrence of seizures is associated with lower IQ, verbal index, preschool achievement, and higher rate of cerebral palsy and speech/language disorders (19,20). The longterm neurologic outcomes of children who have seizures while receiving ECLS are still not well defined, and it remains to be proven that prolonged EEG monitoring and treatment of seizures improves outcomes in this population.…”

Section: Discussionmentioning

confidence: 86%

“…Imaging studies were available for all of the patients with seizures and for 11 of 15 of those with no seizures. There was no statistically significant difference in the timing of imaging, measured from the initiation of ECLS, between those patients who had seizures and those who did not have seizures (time in days [sd] for seizure group, 22 [19] and no-seizure group, 26 [33]; p = 0.83). Images were available for review for 14 patients with abnormal EEG recordings.…”

Section: Correlation Of Eeg Findings and Imaging Studiesmentioning

confidence: 99%

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Nonconvulsive Seizures Are Common in Children Treated With Extracorporeal Cardiac Life Support*

Piantino¹,

Wainwright²,

Grimason³

et al. 2013

Pediatric Critical Care Medicine

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Seizures are common in children during extracorporeal cardiac life support, and most seizures are nonconvulsive. In patients undergoing extracorporeal cardiac life support, clinical features are unreliable indicators of the presence of seizures. The presence of seizures is suggestive of CNS injury. This study is limited by the exclusion of neonates, a feature of the clinical use of electroencephalography at our institution. Although seizures were not associated with increased mortality, further prospective studies in larger populations are needed to assess the long-term morbidity associated with seizures during extracorporeal cardiac life support.

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Section: Discussionmentioning

confidence: 86%

Section: Correlation Of Eeg Findings and Imaging Studiesmentioning

confidence: 99%

Nonconvulsive Seizures Are Common in Children Treated With Extracorporeal Cardiac Life Support*

Piantino¹,

Wainwright²,

Grimason³

et al. 2013

Pediatric Critical Care Medicine

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“…The most common acute abnormality was intracranial hemorrhage which occurred in 37% (30) of patients and included intraventricular hemorrhage in 22% (18) of patients, subdural hemorrhage in 7% (6) of patients, and parenchymal hemorrhage in 11% (9) patients. Other acute abnormalities included hypoxic-ischemic brain injury in 13% (11) of patients, thrombotic stroke in 12% (10) of patients, and cerebral edema in 5% (4) of patients. Acute abnormalities occurred in 45% (29 of 65) of patients without ES and in 71% (12 of 17) of patients with ES (p=0.057).…”

Section: Resultsmentioning

confidence: 99%

“…(10) A single-center study reported clinical seizures in 30% of 50 infants undergoing ECMO. (11) ES have been described as more common than clinically evident seizures with ES reported in 8–21% and electrographic status epilepticus in 11–50% of those with ES. (5, 12–14) However, these studies were smaller and did not perform cEEG in all consecutive patients, and this may explain why the incidence in our project (18%) is higher than previously reported, particularly since 83% of patients with ES experienced exclusively EEG-only seizures which would not be identified without cEEG.…”

Section: Discussionmentioning

confidence: 99%

“…(2, 5, 10–14) Furthermore, seizures during ECMO have been associated with cerebral injury and worse outcomes in some, but not all, studies. (5, 11, 12, 15, 16) However, most of the studies addressing seizure incidence and outcome have included non-consecutive cohorts without standardized use of continuous EEG monitoring (cEEG) to identify ES. (2, 5, 10–14) A recent systematic literature review regarding the use and effectiveness of neuromonitoring methods during ECMO identified only seven studies related to EEG, including two with 1–2 channel amplitude integrated EEG and five with intermittent conventional multi-channel EEG.…”

Section: Introductionmentioning

confidence: 99%

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Electrographic Seizures in Children and Neonates Undergoing Extracorporeal Membrane Oxygenation

Lin

Banwell

Berg

et al. 2017

Pediatric Critical Care Medicine

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Objective We aimed to determine the incidence and risk factors for electrographic seizures (ES) in neonates and children requiring extracorporeal membrane oxygenation (ECMO) support. Design Prospective quality improvement project. Setting Quaternary care pediatric institution. Patients Consistent with American Clinical Neurophysiology Society EEG monitoring recommendations, neonates and children requiring ECMO support underwent clinically indicated EEG monitoring. Interventions We performed a two-year quality improvement study from July 2013 – June 2015 evaluating ES incidence and risk factors. Main Results 99 of 112 patients (88%) requiring ECMO support underwent EEG monitoring. ES occurred in 18 patients (18%), of which 11 patients (61%) had electrographic status epilepticus and 15 patients (83%) had exclusively EEG-only seizures. ES were more common in patients with low cardiac output syndrome (p=0.03). Patients with ES were more likely to die prior to discharge (72% vs 30%, p=0.01) and have unfavorable outcomes (54% vs 17%, p=0.004) than those without ES. Conclusions ES occurred in 18% of neonates and children requiring ECMO support, often constituted electrographic status epilepticus, and were often EEG-only thereby requiring EEG monitoring for identification. Low cardiac output syndrome was associated with an increased risk for ES. ES were associated with higher mortality and unfavorable outcomes. Further investigation is needed to determine whether ES identification and management improves outcomes.

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Comparison of venoarterial versus venovenous access in the cerebral circulation of newborns undergoing extracorporeal membrane oxygenation

Fukuda

Aoyama

Yamada

et al. 1999

Pediatric Surgery International

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This study was designed to compare venoarterial (VA) with venovenous (VV) access in the cerebral circulation of newborn infants during extracorporeal membrane oxygenation (ECMO). Among 14 infants with VA ECMO, 7 had no intracranial complications (group 1), while the others (group 2) developed intracranial hemorrhage (ICH). In contrast, among 19 infants with VV ECMO, only 1 developed ICH. Serial echocardiograms were performed before and after 1, 6, 12, and 24 h and 2 and 3 days of ECMO. The mean cerebral blood flow (CBF) velocities were measured in the anterior cerebral artery (ACA), right and left internal carotid arteries (Rt, Lt-ICA), basilar artery (BA), and right and left middle cerebral arteries (Rt, Lt-MCA). Ejection fraction (EF), cardiac output (CO), and stroke volume (SV) were also measured using standard echography. The velocity levels in the ACA, Rt-MCA, and Lt-MCA in VA ECMO were lower than those in VV ECMO, while those in the Lt-ICA and BA in VA ECMO were higher than those in VV ECMO. The EF, CO, and SV were lower in cases of VA ECMO than in VV ECMO. In cases of VA ECMO, there were no differences between groups 1 and 2 in velocities in the ACA, Rt-ICA, or Lt-ICA. However the velocities in group 2 in the BA, Rt-MCA, and Lt-MCA were lower than those in group 1 before and during ECMO. Similarly, the EF, CO, and SV were lower in group 2 (12.0%-31.0%, 0. 10-0.32 l/min, and 0.66-1.55 ml, respectively) than in group 1 (29. 5%-49.3%, 0.25-0.63 l/min, and 2.15-3.85 ml) during ECMO. However, in the infants on VV ECMO the CBF was either maintained or gradually increased before and during ECMO. Their cardiac parameters were: EF 46.1%-53.0%, CO 0.43-0.52 l/min, and SV 2.72-3.84 ml during ECMO. It is concluded that in VA ECMO CBF velocities, particularly in infants who developed ICH, decreased after the onset of ECMO in association with poor cardiac function, while in VV ECMO they were stable, probably due to normal systemic hemodynamics and cardiac function.

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Significance of seizures associated with extracorporeal membrane oxygenation

Cited by 49 publications

References 9 publications

Nonconvulsive Seizures Are Common in Children Treated With Extracorporeal Cardiac Life Support*

Nonconvulsive Seizures Are Common in Children Treated With Extracorporeal Cardiac Life Support*

Electrographic Seizures in Children and Neonates Undergoing Extracorporeal Membrane Oxygenation

Comparison of venoarterial versus venovenous access in the cerebral circulation of newborns undergoing extracorporeal membrane oxygenation

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