Sansevere Arnold J, DiBacco Melissa L, Cavan Kelly, Rotenberg Alexander
Division of Epilepsy and Neurophysiology, Boston Children's Hospital, Boston, MA, U.S.A.
Department of Neurology, Boston Children's Hospital, Boston, MA, U.S.A.
J Clin Neurophysiol. 2024 Nov 25;42(5):416-421. doi: 10.1097/WNP.0000000000001128.
To assess the alpha-delta ratio (ADR) as a biomarker for cerebral injury and stroke in pediatric extracorporeal membrane oxygenation (ECMO).
Retrospective study of children aged >44 weeks gestation to 21 years monitored with continuous electroencephalography during ECMO. The interhemispheric ADR difference between the left and right hemisphere was calculated per hour. A t -test was performed comparing the mean interhemispheric difference between controls and patients with cerebral injury at set intervals (i.e., 1, 3, 6, 9, 12, and 24 hours) from the start of continuous electroencephalography. Injury was established if confirmed by imaging on the same day as ECMO cannulation and acquired if confirmed the day after ECMO or later. Analysis of variance was performed to compare the mean interhemispheric difference in the ADR among control patients to those with early-acquired and late-acquired injury at 24 hours.
We included 49 patients with a median age of 3.4 years (interquartile range [1-10.4]), 47% (23/49) were male, and 73% (36/49) had cardiac arrest. Cerebrovascular injury was detected in 45% (22/49), with focal stroke in 82% (18/22). A significant difference was seen between control patients compared with cerebrovascular injury after 6 hours of continuous electroencephalography (0.016 vs. 0.042) (mean interhemispheric ADR difference) ( P = 0.03). Analysis of variance of control patients to early- and late-acquired injury at 24 hours showed a significant difference ( P = 0.03).
The ADR is a reliable metric to detect in-ECMO cerebral injury and stroke. Further study is needed to automate and assess this metric for real-time detection of stroke in ECMO.
评估α-δ比值（ADR）作为小儿体外膜肺氧合（ECMO）中脑损伤和中风的生物标志物。
对孕周>44周至21岁的儿童进行回顾性研究，这些儿童在ECMO期间接受连续脑电图监测。每小时计算左右半球之间的半球间ADR差异。在连续脑电图开始后的设定时间间隔（即1、3、6、9、12和24小时），进行t检验，比较对照组与脑损伤患者的平均半球间差异。如果在ECMO插管当天通过影像学证实，则确定为损伤；如果在ECMO后一天或更晚证实，则确定为获得性损伤。进行方差分析，比较24小时时对照组患者与早期和晚期获得性损伤患者在ADR方面的平均半球间差异。
我们纳入了49例患者，中位年龄为3.4岁（四分位间距[1-10.4]），47%（23/49）为男性，73%（36/49）发生心脏骤停。45%（22/49）检测到脑血管损伤，其中82%（18/22）为局灶性中风。连续脑电图6小时后，对照组患者与脑血管损伤患者之间存在显著差异（0.016对0.042）（平均半球间ADR差异）（P = 0.03）。24小时时对照组患者与早期和晚期获得性损伤的方差分析显示存在显著差异（P = 0.03）。
ADR是检测ECMO期间脑损伤和中风的可靠指标。需要进一步研究以实现该指标的自动化并评估其在ECMO中实时检测中风的能力。
