Department of Surgery, New York - Presbyterian, Columbia University Herbert and Florence Irving Medical Center, New York, NY.
College of Physicians and Surgeons, New York - Presbyterian, Columbia University Herbert and Florence Irving Medical Center, New York, NY.
Pediatr Crit Care Med. 2018 Dec;19(12):1162-1167. doi: 10.1097/PCC.0000000000001730.
Standards for neuromonitoring during extracorporeal membrane oxygenation support do not currently exist, and there is wide variability in practice. We present our institutional experience at an academic children's hospital since establishment of a continuous electroencephalography monitoring protocol for extracorporeal membrane oxygenation patients.
Retrospective, single-center study.
Neonatal ICU and PICU in an urban, quaternary care center.
All neonatal and pediatric patients requiring extracorporeal membrane oxygenation.
None.
During the study period, 70 patients were cannulated for extracorporeal membrane oxygenation and had continuous electroencephalography monitoring for greater than 24 hours. Electroencephalographic seizures were observed in 16 of 70 patients (23%), including five patients (7%) who were in status epilepticus. Among patients with continuous electroencephalography seizures, nine (56%) had subclinical nonconvulsive status epilepticus and eight (50%) had seizures in the initial 24 hours of extracorporeal membrane oxygenation support. Survival to hospital discharge was significantly greater for extracorporeal membrane oxygenation patients without seizures (74% vs 44%; p = 0.02).
Seizures occur in a significant proportion of pediatric and neonatal extracorporeal membrane oxygenation patients, frequently in the initial 24 hours after extracorporeal membrane oxygenation cannulation. Because seizures are associated with significantly decreased survival, neuromonitoring early in the extracorporeal membrane oxygenation course is important and useful. Further studies are needed to correlate electroencephalography findings with neurologic outcome.
目前体外膜肺氧合支持过程中的神经监测标准尚不存在，且实践中存在广泛的变异性。我们介绍了在建立针对体外膜肺氧合患者的连续脑电图监测方案后，我们在一家学术儿童医院的机构经验。
回顾性、单中心研究。
城市四级保健中心的新生儿 ICU 和 PICU。
所有需要体外膜肺氧合的新生儿和儿科患者。
无。
在研究期间，70 名患者接受了体外膜肺氧合插管，并进行了超过 24 小时的连续脑电图监测。70 名患者中有 16 名（23%）观察到脑电图发作，其中 5 名（7%）患者处于癫痫持续状态。在有连续脑电图发作的患者中，9 名（56%）有亚临床非惊厥性癫痫持续状态，8 名（50%）在体外膜肺氧合支持的最初 24 小时内有发作。无癫痫发作的体外膜肺氧合患者的存活率显著更高（74%比 44%；p=0.02）。
在相当一部分儿科和新生儿体外膜肺氧合患者中会出现癫痫发作，通常发生在体外膜肺氧合插管后的最初 24 小时内。因为癫痫发作与存活率显著降低相关，因此在体外膜肺氧合过程早期进行神经监测很重要且有用。需要进一步的研究来将脑电图发现与神经结局相关联。
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