Stroke in pediatric ECMO patients: analysis of the National Inpatient Sample (NIS) database

Ezetendu, Chidiebere; Baloğlu, Orkun; Othman, Hasan F.; Nandakumar, V; Latifi, Samir; Aly, Hany

doi:10.1038/s41390-022-02088-7

Cited by 8 publications

(6 citation statements)

References 30 publications

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“…Categories delineating race or ethnicity varied markedly. Overall, 54 studies (58%) found no statistical association between race and/or ethnicity and outcome (37–76), while 36 (39%) observed adverse outcomes in populations from underrepresented/diverse racial or ethnic backgrounds (Black/African American, Asian, Hispanic, or “other”/“non-Caucasian”/“non-White”). Of citations identifying adverse outcomes, 8 (22%) used univariate (77–84) and 28 (78%) used multivariate analyses.…”

Section: Resultsmentioning

confidence: 99%

Health Disparities in Extracorporeal Membrane Oxygenation Utilization and Outcomes: A Scoping Review and Methodologic Critique of the Literature*

Moynihan

Dorste

Alizadeh

et al. 2023

Critical Care Medicine

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Objectives: To map the scope, methodological rigor, quality, and direction of associations between social determinants of health (SDoH) and extracorporeal membrane oxygenation (ECMO) utilization or outcomes. Data Sources: PubMed, Web of Science, Embase, and Cochrane Library databases were systematically searched for citations from January 2000 to January 2023, examining socioeconomic status (SES), race, ethnicity, hospital and ECMO program characteristics, transport, and geographic location (context) with utilization and outcomes (concept) in ECMO patients (population). Study Selection: Methodology followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses scoping review extension. Two reviewers independently evaluated abstracts and full text of identified publications. Exclusion criteria included non-English, unavailable, less than 40 patients, and periprocedural or mixed mechanical support. Data Extraction: Content analysis used a standardized data extraction tool and inductive thematic analysis for author-proposed mediators of disparities. Risk of bias was assessed using the Quality in Prognosis Studies tool. Data Synthesis: Of 8,214 citations screened, 219 studies were identified. Primary analysis focuses on 148 (68%) including race/ethnicity/SES/payer variables including investigation of ECMO outcomes 114 (77%) and utilization 43 (29%). SDoH were the primary predictor in 15 (10%). Overall quality and methodologic rigor was poor with advanced statistics in 7%. Direction of associations between ECMO outcomes or utilization according to race, ethnicity, SES, or payer varied. In 38% adverse outcomes or lower use was reported in underrepresented, under-resourced or diverse populations, while improved outcomes or greater use were observed in these populations in 7%, and 55% had no statistically significant result. Only 26 studies (18%) discussed mechanistic drivers of disparities, primarily focusing on individual- and hospital-level rather than systemic/structural factors. Conclusions: Associations between ECMO utilization and outcomes with SDoH are inconsistent, complicated by population heterogeneity and analytic shortcomings with limited consideration of systemic contributors. Findings and research gaps have implications for measuring, analyzing, and interpreting SDoH in ECMO research and healthcare.

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Section: Resultsmentioning

confidence: 99%

Health Disparities in Extracorporeal Membrane Oxygenation Utilization and Outcomes: A Scoping Review and Methodologic Critique of the Literature*

Moynihan

Dorste

Alizadeh

et al. 2023

Critical Care Medicine

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“…93,94 Mechanical Support (ECMO or Ventricular Assist Device) Patients supported by ECMO are at high risk for stroke and hypoxic-ischemic injury. 99 Stroke may be secondary to thromboembolic events related to circuit issues or ineffective anticoagulation. Hypoxic-ischemic injury may occur before ECMO, secondary to cardiac arrest or severe hypotension, or during ECMO secondary to hypotension from circuit issues.…”

Section: Cardiopulmonary Resuscitationmentioning

confidence: 99%

Neurodevelopmental Outcomes for Individuals With Congenital Heart Disease: Updates in Neuroprotection, Risk-Stratification, Evaluation, and Management: A Scientific Statement From the American Heart Association

Sood,

Newburger,

Anixt

et al. 2024

Circulation

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Over the past decade, new research has advanced scientific knowledge of neurodevelopmental trajectories, factors that increase neurodevelopmental risk, and neuroprotective strategies for individuals with congenital heart disease. In addition, best practices for evaluation and management of developmental delays and disorders in this high-risk patient population have been formulated based on literature review and expert consensus. This American Heart Association scientific statement serves as an update to the 2012 statement on the evaluation and management of neurodevelopmental outcomes in children with congenital heart disease. It includes revised risk categories for developmental delay or disorder and an updated list of factors that increase neurodevelopmental risk in individuals with congenital heart disease according to current evidence, including genetic predisposition, fetal and perinatal factors, surgical and perioperative factors, socioeconomic disadvantage, and parental psychological distress. It also includes an updated algorithm for referral, evaluation, and management of individuals at high risk. Risk stratification of individuals with congenital heart disease with the updated categories and risk factors will identify a large and growing population of survivors at high risk for developmental delay or disorder and associated impacts across the life span. Critical next steps must include efforts to prevent and mitigate developmental delays and disorders. The goal of this scientific statement is to inform health care professionals caring for patients with congenital heart disease and other key stakeholders about the current state of knowledge of neurodevelopmental outcomes for individuals with congenital heart disease and best practices for neuroprotection, risk stratification, evaluation, and management.

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“…Extracorporeal membrane oxygenation (ECMO) provides life-saving support to critically ill patients who experience refractory cardiopulmonary failure 1 . The utility of ECMO has increased worldwide 2 and despite clear bene t, its use is associated with signi cant morbidity commonly attributed to acute brain injury [3][4][5][6] . Timely detection of acute brain injury in this population is necessary to mitigate secondary brain injury and improve outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…Median length of hospital stay was 35 (IQR) days. Median length of ECMO duration was 7 (IQR[3][4][5][6][7][8][9][10][11][12][13]) days.Abbreviations: AIS, arterial ischemic stroke; FiO 2 , Fractionated inspired oxygenation; HIBI, hypoxic ischemic brain injury; HS, hemorrhagic stroke; lpm, liters per minute; mm, millimeters; % percent. Abbreviations: AIS, arterial ischemic stroke; FiO 2 , Fractionated inspired oxygenation; HIBI, hypoxic ischemic brain injury; HS, hemorrhagic stroke; lpm, liters per minute; mm, millimeters; % percent.…”

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confidence: 99%

Neurophysiologic Features Predicting Brain Injury During Pediatric ECMO Support

Hanalioglu,

Temkit,

Hildebrandt

et al. 2023

Preprint

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Background/Objective: Extracorporeal membrane oxygenation (ECMO) provides life-saving support to critically ill patients who experience refractory cardiopulmonary failure but carries high risk of acute brain injury. We aimed to identify characteristics predicting acute brain injury in children requiring ECMO support.Methods This is a prospective observational study from 2019–2022 of pediatric ECMO patients undergoing neuromonitoring including continuous electroencephalography, cerebral oximetry, and transcranial Doppler ultrasound (TCD). Primary outcome was acute brain injury. Clinical and neuromonitoring characteristics were collected. Multivariate logistic regression was implemented to model odds ratios (OR) and identify the combined characteristics that best discriminate risk of acute brain injury using the area under the receiver operating characteristic curve (AUROC).Results Seventy-five pediatric patients requiring ECMO support were enrolled in this study. Of the seventy-five patients enrolled, nineteen experienced acute brain injury (25.3%), including seven (36.8%) with arterial ischemic stroke, four (21.1%) with hemorrhagic stroke, seven with hypoxic ischemic brain injury (36.8%) and one (5.3%) with both arterial ischemic stroke and hypoxic ischemic brain injury. Univariate analysis demonstrated acute brain injury to be associated with maximum hourly seizure burden (p = 0.026), epileptiform discharges (p = 0.020), electroencephalographic suppression ratio (p = 0.014), increased interhemispheric differences in electroencephalographic total power (p = 0.023) and amplitude (p = 0.011), and increased differences in TCD Thrombolysis in Brain Ischemia (TIBI) scores between bilateral middle cerebral arteries (p = 0.049). Best subset model selection identified increased seizure burden (OR = 3.86, partial R-squared 0.40, p = 0.013), increased quantitative electroencephalographic interhemispheric amplitude differences (OR = 2.69, partial R-squared 0.18, p = 0.007), and increased interhemispheric TCD TIBI score differences (OR = 4.97, partial R-squared 0.22, p = 0.005) to be independently predictive toward acute brain injury (AUROC = 0.92).Conclusions Increased seizure burden, increased interhemispheric differences in quantitative electroencephalographic amplitude and increased TCD TIBI scores each independently predict acute brain injury in children undergoing ECMO support.

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Stroke in pediatric ECMO patients: analysis of the National Inpatient Sample (NIS) database

Cited by 8 publications

References 30 publications

Health Disparities in Extracorporeal Membrane Oxygenation Utilization and Outcomes: A Scoping Review and Methodologic Critique of the Literature*

Health Disparities in Extracorporeal Membrane Oxygenation Utilization and Outcomes: A Scoping Review and Methodologic Critique of the Literature*

Neurodevelopmental Outcomes for Individuals With Congenital Heart Disease: Updates in Neuroprotection, Risk-Stratification, Evaluation, and Management: A Scientific Statement From the American Heart Association

Neurophysiologic Features Predicting Brain Injury During Pediatric ECMO Support

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