Keenan, Julia

Ryan, Julia

Sansevere, Arnold

English

George Washington University: Health Sciences Research Commons (HSRC)

EEG Predictors of Neurologic Injury in Patients Undergoing Extracorporeal Membrane OxygenationJulia Ryan, MHS; Julia Keenan, BS; Arnold Sansevere, MDTo assess electrographic associations of brain injury in children undergoing extracorporeal membrane oxygenation (ECMO).This is a retrospective review of all patients on ECMO admitted to the pediatric and cardiac intensive care units (PICU, CICU) at Children’s National Hospital from August 2019 to December 2022. Clinical variables included age, sex, ECMO indication, presence or absence of congenital heart disease, duration on ECMO, initial type of ECMO (veno-arterial (VA)/veno-venous (VV)), and total number of ECMO runs. EEG features collected were based on the duration of the first ECMO run and included EEG background and presence or absence of electrographic seizures (ES). EEG background within the first 24 hours was defined as normal (both neonate and non-neonate), mildly abnormal (slow-disorganized in non-neonate; excess discontinuity in neonate), moderately abnormal (discontinuous in non-neonate), or severely abnormal (attenuated/featureless/burst suppression in neonate and non-neonate). Imaging features included ischemic, anoxic, hemorrhagic (extra-axial, intraparenchymal, or intraventricular hemorrhage), or combined injury. A chi-squared test was used to assess the association of EEG features, ES, and injury.Severity of EEG background and presence of ES was associated with the development of brain injury in patients on ECMO. We hope to further explore the ability of EEG background and ES to localize and predict degree of brain injury in this population.OBJECTIVEMETHODSCONCLUSIONSOne hundred and twelve patients met inclusion criteria with a mean age of 2.97 years (IQR 0.4-31.2). Forty-four percent (49/112) were female, 84% had congenital heart disease, 93% (104/112) had EEG, and 95% (106/112) had neuroimaging. The most common indication for ECMO was cardiopulmonary arrest (50/112). Nineteen percent (21/112) were admitted to the PICU and 81% (92/112) were admitted to the CICU with a mean duration on ECMO of 67.66 hours (IQR 49.1-155.6). VA ECMO, including both central and peripheral, was the most common approach to cannulation (90%, 101/112). Seventy-nine percent (89/112) had a single ECMO run, whereas 21% (23/112) had multiple ECMO runs. A mildly abnormal EEG background was the most common finding (77%, 80/112), and 6% (6/104) had a severely abnormal background. Thirty-eight percent (40/104) had ES, the majority of which occurred on the first day of cannulation (25%; 10/40). Fifty-three percent (59/112) had brain injury and the most common injury type was anoxic (22%, 13/59). A severely abnormal EEG background (p=0.028) and presence of electrographic seizures (p<0.0001) while on ECMO was associated with the development of brain injury.RESULTS Demographics Age on ECMO 2.97 yearsFemale:Male 49 (44%) : 63 (56%)Reason for ECMOCardiac ArrestCardiac FailurePost-operativeRespiratory IllnessSystemic Illness More than one indication 50 (45%)21 (19%)23 (20%)11 (10%)6 (5%)1 (1%)Clinical FeaturesCongenital heart diseasePICUCICUDuration on ECMOVA ECMO- peripheral VA ECMO- central VV ECMONumber of ECMO runs       Single       Multiple94 (84%)21 (19%)92 (81%)67.66 hours56 (50%)45 (40%)11 (10%)89 (79%)23 (21%)EEG FeaturesPatients with EEGBackground      Normal     Mildly abnormal     Moderately abnormal     Severely abnormalElectrographic seizures104 (93%)11 (10%)80 (77%)7 (7%)6 (6%)40 (38%)InjuryBrain Injury Type of Injury     Ischemic      Anoxic     Hemorrhagic     CombinedMortality59 (53%)8 (14%)13 (22%)11 (19%)27 (45%)52 (46%)

EEG Predictors of Neurologic Injury in Patients Undergoing Extracorporeal Membrane Oxygenation

https://hsrc.himmelfarb.gwu.edu/cgi/viewcontent.cgi?article=1241&context=gw_research_showcase

EEG Predictors of Neurologic Injury in Patients Undergoing Extracorporeal Membrane Oxygenation

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