LaRovere Kerri L, Vonberg Frederick W, Prabhu Sanjay P, Kapur Kush, Harini Chellamani, Garcia-Jacques Rogelio, Chao Jessica H, Akhondi-Asl Aliresa, Thiagarajan Ravi, Tasker Robert C
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.
Pediatr Neurol. 2017 Aug;73:64-70. doi: 10.1016/j.pediatrneurol.2017.05.006. Epub 2017 May 18.
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.
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.
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).
Head ultrasound is insufficient to rule out infarction. Infarction is middle cerebral artery predominant and associated with an increased risk of electrographic seizures.
我们试图对小儿体外膜肺氧合（ECMO）期间头部计算机断层扫描（CT）上急性梗死和出血的类型及分布进行分类。我们还分析了脑电图上癫痫发作的发生情况以及有无CT异常者的预后。
我们在儿科重症监护病房进行了一项单中心观察性研究。回顾了2009年至2013年间179例接受ECMO治疗的儿童的病历。未进行干预。
共有46%（82/179）的儿童接受了CT检查。其中，60%（49/82）有急性病变。脑梗死发生率为55%（27/49），出血发生率为41%（20/49）。67%（18/27）的梗死为动脉性，以大脑中动脉区域为主（17例患者）。41%（11/27）的梗死为双侧性，其余与插管侧无关。头部超声预测CT上梗死的敏感性和特异性分别为100%和53%。共有36%（65/179）的患者接受了连续脑电图监测；其中22%（14/65）有脑电图癫痫发作。梗死患者的脑电图癫痫发作增加（比值比[OR]，6.81；95%置信区间[CI]，1.98至23.43）。梗死（OR，0.22；95%CI，0.09至0.54）和出血（OR，0.31；95%CI，0.13至0.72）均导致生存率降低。CT异常的儿童预后更差（P = 0.01）。
头部超声不足以排除梗死。梗死以大脑中动脉为主，且与脑电图癫痫发作风险增加相关。
