Section of Pediatric Critical Care, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
Department of Biostatistics, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA.
Neurocrit Care. 2022 Feb;36(1):157-163. doi: 10.1007/s12028-021-01276-3. Epub 2021 Jul 15.
Children supported with extracorporeal membrane oxygenation (ECMO) have been shown to be at risk for developing seizures. However, previous studies have consisted of heterogeneous patient populations. We aimed to describe the rate of seizures in pediatric patients receiving ECMO for cardiac indications and to identify risk factors for the occurrence of this complication.
This is a retrospective cohort study of consecutive pediatric patients on ECMO for congenital or acquired cardiac disease between 2014 and 2018 at a tertiary care pediatric hospital.
We reviewed 110 children, of whom 104 (95%) received continuous electroencephalogram for at least 48 h after ECMO initiation. Seizures were observed in 20 (18%) children. Seizures were subclinical only in 13 (65%) patients, and 8 (40%) developed status epilepticus. The median time from ECMO initiation to first seizure was 34 h (25%, 75%: 19, 44). Children with seizures were more likely to have suffered pre-ECMO cardiac arrest (odds ratio 5.7, 95% confidence interval 2.0-16.1, p < 0.001), require extracorporeal cardiopulmonary resuscitation (odds ratio 5.2, 95% confidence interval 1.9-14.7, p < 0.001), and have been cannulated via the cervical vessels (p = 0.029). Children with seizures also had lower pH nadir prior to ECMO (p = 0.015) and had higher peak lactate prior to ECMO (p = 0.002). Patients with seizures had significantly a longer median intensive care unit length of stay, (43 versus 32 days, p = 0.02), had a significantly worse pediatric cerebral performance score (2 versus 1, p = 0.03), and tended to have worse survival to hospital discharge (50% versus 71%, p = 0.069).
Seizures in pediatric patients on ECMO for cardiac indications are common, occurring in nearly one in five patients. Seizures are frequently subclinical only and often progress to status epilepticus. Continuous electroencephalogram is therefore warranted for this patient population, especially in the setting of cardiac arrest, extracorporeal cardiopulmonary resuscitation, or severe metabolic acidosis.
体外膜肺氧合（ECMO）支持的儿童存在发生癫痫的风险。然而，先前的研究包括了异质的患者群体。我们旨在描述接受 ECMO 治疗心脏指征的儿科患者癫痫发作的发生率，并确定发生这种并发症的危险因素。
这是一项对 2014 年至 2018 年在一家三级儿科医院接受 ECMO 治疗先天性或后天性心脏疾病的连续儿科患者的回顾性队列研究。
我们回顾了 110 名儿童，其中 104 名（95%）在 ECMO 启动后至少 48 小时内接受连续脑电图检查。20 名（18%）儿童出现癫痫发作。只有 13 名（65%）患者的癫痫发作是亚临床的，8 名（40%）发展为癫痫持续状态。从 ECMO 启动到首次癫痫发作的中位时间为 34 小时（25%，75%：19，44）。有癫痫发作的儿童更有可能在 ECMO 前发生心脏骤停（优势比 5.7，95%置信区间 2.0-16.1，p<0.001），需要体外心肺复苏（优势比 5.2，95%置信区间 1.9-14.7，p<0.001），并且通过颈部血管插管（p=0.029）。有癫痫发作的儿童在 ECMO 前的 pH 最低值也较低（p=0.015），在 ECMO 前的血乳酸峰值较高（p=0.002）。有癫痫发作的患者 ICU 住院时间中位数明显较长（43 天与 32 天，p=0.02），小儿脑功能表现评分明显较差（2 分与 1 分，p=0.03），且住院期间死亡率较高（50%与 71%，p=0.069）。
接受 ECMO 治疗心脏指征的儿科患者癫痫发作较为常见，近五分之一的患者会出现这种情况。癫痫发作通常是亚临床的，且常常进展为癫痫持续状态。因此，这种患者群体需要连续脑电图检查，尤其是在心脏骤停、体外心肺复苏或严重代谢性酸中毒的情况下。
