Katherine Cashen1, Ron W Reeder2, Christina Shanti3, Heidi J Dalton4, J Michael Dean2, Kathleen L Meert1. 1. 1 Department of Pediatrics, Division of Critical Care, Children's Hospital of Michigan/Wayne State University, Detroit, MI, USA. 2. 2 Department of Pediatrics, University of Utah, Salt Lake City, UT, USA. 3. 3 Department of General Surgery, Children's Hospital of Michigan/Wayne State University, Detroit, MI, USA. 4. 4 Department of Pediatrics, Inova Fairfax Hospital, Falls Church, VA, USA.
Abstract
INTRODUCTION: The use of therapeutic hypothermia during neonatal extracorporeal membrane oxygenation (ECMO) as a neurologic protective strategy has gained interest among clinicians despite limited data. Our objective is to describe the relationship between the use of therapeutic hypothermia during neonatal ECMO and complications, mortality and functional status among survivors. METHODS: Secondary analysis of data collected by the Collaborative Pediatric Critical Care Research Network between December 2012 and September 2014. Data were collected prospectively from 267 neonates (<30 days) undergoing ECMO at eight clinical sites. Twenty neonates received therapeutic hypothermia. RESULTS: Neonates receiving therapeutic hypothermia were more likely to have intracranial hemorrhage during the first seven days of ECMO than were non-hypothermic neonates (40.0% vs 15.8%, p=0.012). No differences were observed between groups for hospital mortality or functional status at hospital discharge among survivors. Variables independently associated with intracranial hemorrhage in the first seven days of ECMO included therapeutic hypothermia, gestational age at birth, age at initiation of ECMO, fibrinogen concentration and mode of ECMO. CONCLUSION: Therapeutic hypothermia during neonatal ECMO appears to be associated with intracranial hemorrhage.
INTRODUCTION: The use of therapeutic hypothermia during neonatal extracorporeal membrane oxygenation (ECMO) as a neurologic protective strategy has gained interest among clinicians despite limited data. Our objective is to describe the relationship between the use of therapeutic hypothermia during neonatal ECMO and complications, mortality and functional status among survivors. METHODS: Secondary analysis of data collected by the Collaborative Pediatric Critical Care Research Network between December 2012 and September 2014. Data were collected prospectively from 267 neonates (<30 days) undergoing ECMO at eight clinical sites. Twenty neonates received therapeutic hypothermia. RESULTS: Neonates receiving therapeutic hypothermia were more likely to have intracranial hemorrhage during the first seven days of ECMO than were non-hypothermic neonates (40.0% vs 15.8%, p=0.012). No differences were observed between groups for hospital mortality or functional status at hospital discharge among survivors. Variables independently associated with intracranial hemorrhage in the first seven days of ECMO included therapeutic hypothermia, gestational age at birth, age at initiation of ECMO, fibrinogen concentration and mode of ECMO. CONCLUSION: Therapeutic hypothermia during neonatal ECMO appears to be associated with intracranial hemorrhage.
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