Zeenia C Billimoria1, Natalie E Rintoul2, Kevin M Sullivan3, Shannon E Hamrick4, Rachel Chapman5, Ulrike Mietzsch6, Sarah Keene4, An N Massaro7, Ruth B Seabrook8, Robert J DiGeronimo6. 1. University of Washington School of Medicine, Seattle, WA, USA. zeenia.billimoria@seattlechildrens.org. 2. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 3. Alfred I. duPont Hospital for Children, Wilmington, DE, USA. 4. Emory University School of Medicine, Atlanta, GA, USA. 5. USC Keck School of Medicine, Los Angeles, CA, USA. 6. University of Washington School of Medicine, Seattle, WA, USA. 7. The George Washington University School of Medicine, Washington, DC, USA. 8. Ohio State University College of Medicine, Columbus, OH, USA.
Abstract
OBJECTIVE: To determine practice variation in the utilization of neuromonitoring modalities in neonatal extracorporeal membrane oxygenation (ECMO) patients across Level IV neonatal intensive care units (NICUs). STUDY DESIGN: Cross-sectional survey design using electronic surveys sent to site sponsors of a multicenter collaborative of 34 Level IV NICUs of the Children's Hospitals Neonatal Consortium (CHNC) from June to August 2018. RESULTS: We had 22 survey respondents from CHNC ECMO centers. Twenty-seven percent of respondents routinely monitored for seizures using electroencephalogram. Cerebral near infrared spectroscopy was used by 50%. Head ultrasound was performed by 95% but the frequency, duration, and type of views varied. Post ECMO screening brain MRI prior to hospital discharge was routinely performed by 77% of respondents. A majority of centers (95%) performed neurodevelopmental follow-up after hospital discharge. CONCLUSIONS: There is variation in neuromonitoring practices in Level IV NICUs performing ECMO. Lack of evidence and clear outcome benefits has contributed to practice variation across institutions.
OBJECTIVE: To determine practice variation in the utilization of neuromonitoring modalities in neonatal extracorporeal membrane oxygenation (ECMO) patients across Level IV neonatal intensive care units (NICUs). STUDY DESIGN: Cross-sectional survey design using electronic surveys sent to site sponsors of a multicenter collaborative of 34 Level IV NICUs of the Children's Hospitals Neonatal Consortium (CHNC) from June to August 2018. RESULTS: We had 22 survey respondents from CHNC ECMO centers. Twenty-seven percent of respondents routinely monitored for seizures using electroencephalogram. Cerebral near infrared spectroscopy was used by 50%. Head ultrasound was performed by 95% but the frequency, duration, and type of views varied. Post ECMO screening brain MRI prior to hospital discharge was routinely performed by 77% of respondents. A majority of centers (95%) performed neurodevelopmental follow-up after hospital discharge. CONCLUSIONS: There is variation in neuromonitoring practices in Level IV NICUs performing ECMO. Lack of evidence and clear outcome benefits has contributed to practice variation across institutions.