Kerri L LaRovere1, Frederick W Vonberg2, Sanjay P Prabhu3, Kush Kapur4, Chellamani Harini4, Rogelio Garcia-Jacques2, Jessica H Chao4, Aliresa Akhondi-Asl2, Ravi Thiagarajan5, Robert C Tasker6. 1. Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts. Electronic address: kerri.larovere@childrens.harvard.edu. 2. Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts. 3. Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts. 4. Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts. 5. Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts. 6. Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
Abstract
BACKGROUND: We sought to classify type and distribution of acute infarction and hemorrhage on head computed tomography (CT) during pediatric extracorporeal membrane oxygenation (ECMO). We also analyzed the occurrence of seizures on electroencephalography and outcomes between those with and without CT abnormalities. METHODS: We conducted a single center observational study in pediatric intensive care units. The medical records of 179 children who underwent ECMO between 2009 and 2013 were reviewed. No interventions were done. RESULTS: A total of 46% (82/179) of children underwent CT. Of these, 60% (49/82) had acute pathology. Cerebral infarction occurred in 55% (27/49) and hemorrhage in 41% (20/49). Infarction was arterial in 67% (18/27) with a preponderance in the middle cerebral artery territory (17 patients). Infarction was bilateral in 41% (11/27) and not specific to the side of cannulation in the rest. Sensitivity and specificity for head ultrasound in predicting infarction on CT were 100% and 53%, respectively. A total of 36% (65/179) underwent continuous encephalography monitoring; 22% (14/65) of these had electrographic seizures. Electrographic seizures were increased in those with infarction (odds ratio [OR], 6.81; 95% confidence interval [CI], 1.98 to 23.43). Survival was reduced with both infarction (OR, 0.22; 95% CI, 0.09 to 0.54) and hemorrhage (OR, 0.31; 95% CI, 0.13 to 0.72). Children with CT abnormalities had more unfavorable outcomes (P = 0.01). CONCLUSIONS: Head ultrasound is insufficient to rule out infarction. Infarction is middle cerebral artery predominant and associated with an increased risk of electrographic seizures.
BACKGROUND: We sought to classify type and distribution of acute infarction and hemorrhage on head computed tomography (CT) during pediatric extracorporeal membrane oxygenation (ECMO). We also analyzed the occurrence of seizures on electroencephalography and outcomes between those with and without CT abnormalities. METHODS: We conducted a single center observational study in pediatric intensive care units. The medical records of 179 children who underwent ECMO between 2009 and 2013 were reviewed. No interventions were done. RESULTS: A total of 46% (82/179) of children underwent CT. Of these, 60% (49/82) had acute pathology. Cerebral infarction occurred in 55% (27/49) and hemorrhage in 41% (20/49). Infarction was arterial in 67% (18/27) with a preponderance in the middle cerebral artery territory (17 patients). Infarction was bilateral in 41% (11/27) and not specific to the side of cannulation in the rest. Sensitivity and specificity for head ultrasound in predicting infarction on CT were 100% and 53%, respectively. A total of 36% (65/179) underwent continuous encephalography monitoring; 22% (14/65) of these had electrographic seizures. Electrographic seizures were increased in those with infarction (odds ratio [OR], 6.81; 95% confidence interval [CI], 1.98 to 23.43). Survival was reduced with both infarction (OR, 0.22; 95% CI, 0.09 to 0.54) and hemorrhage (OR, 0.31; 95% CI, 0.13 to 0.72). Children with CT abnormalities had more unfavorable outcomes (P = 0.01). CONCLUSIONS: Head ultrasound is insufficient to rule out infarction. Infarction is middle cerebral artery predominant and associated with an increased risk of electrographic seizures.
Authors: Sarah L Bauer Huang; Ahmed S Said; Christopher D Smyser; John C Lin; Kristin P Guilliams; Réjean M Guerriero Journal: J Child Neurol Date: 2020-10-28 Impact factor: 1.987