Baker Alyson, Shah Ekta, Ouyang Amy, Silver Maya, Tomko Stuart R, Guilliams Kristin, Said Ahmed S, Guerriero Réjean M
Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, USA.
Nebraska Children's, Omaha, NE, USA.
Neurocrit Care. 2025 Apr 17. doi: 10.1007/s12028-025-02248-7.
The objective of this study was to identify clinical and continuous electroencephalogram (cEEG) variables associated with outcomes of pediatric venoarterial (V-A) extracorporeal membrane oxygenation support (ECMO).
We conducted a retrospective single-center study of pediatric patients on V-A ECMO between January 1, 2015, and September 30, 2020. Serial clinical and cEEG variables were collected to assess the relationship of pre- and on-ECMO variables with hospital mortality in patients who underwent cEEG monitoring.
Ninety-four patients undergoing V-A ECMO had cEEG monitoring, with a hospital mortality of 43%. Nonsurvivors had significantly lower pH and higher lactate levels prior to ECMO initiation. Nineteen (20%) had seizures, with 7 (7%) developing status epilepticus. In the first 24 h patients were on ECMO, unfavorable background score and lack of cEEG variability or reactivity were associated with mortality. A multivariable model investigating in-hospital mortality that included pH and lactate level 2 h prior to ECMO initiation, presence of electrographic seizures, and asymmetry on cEEG as variables, had an area under the receiver operating characteristic curve (AUROC) of 0.8 (95% confidence interval [CI] 0.74-0.86, p < 0.02). The model for on-ECMO mortality (ECMO nonsurvivors) that included pH 2 h prior to ECMO initiation, presence of electrographic seizures, and lack of variability/reactivity at any point on cEEG as variables had an AUROC of 0.85 (95% CI 0.8-0.9, p < 0.001).
These data demonstrate an association of evolving pre-ECMO impaired tissue oxygenation and on-ECMO neurophysiologic impairment, measured by cEEG, with mortality. They provide preliminary evidence that the timing of ECMO initiation, in relation to worsening tissue oxygenation, should be investigated further, and cEEG may be used to evaluate the potential impact on both neurologic injury and mortality.
本研究的目的是确定与小儿静脉 - 动脉（V - A）体外膜肺氧合支持（ECMO）结局相关的临床和连续脑电图（cEEG）变量。
我们对2015年1月1日至2020年9月30日期间接受V - A ECMO治疗的儿科患者进行了一项回顾性单中心研究。收集系列临床和cEEG变量，以评估接受cEEG监测的患者在ECMO治疗前和治疗期间的变量与医院死亡率之间的关系。
94例接受V - A ECMO治疗的患者进行了cEEG监测，医院死亡率为43%。非幸存者在开始ECMO治疗前的pH值显著较低，乳酸水平较高。19例（20%）发生癫痫，其中7例（7%）发展为癫痫持续状态。在患者接受ECMO治疗的最初24小时内，不良背景评分以及cEEG缺乏变异性或反应性与死亡率相关。一个多变量模型用于研究住院死亡率，该模型将ECMO开始前2小时的pH值和乳酸水平、脑电图癫痫发作的存在以及cEEG的不对称性作为变量，其受试者操作特征曲线下面积（AUROC）为0.8（95%置信区间[CI] 0.74 - 0.86，p < 0.02）。用于ECMO治疗期间死亡率（ECMO非幸存者）的模型将ECMO开始前2小时的pH值、脑电图癫痫发作的存在以及cEEG在任何时间点缺乏变异性/反应性作为变量，其AUROC为0.85（95% CI 0.8 - 0.9，p < 0.001）。
这些数据表明，通过cEEG测量，ECMO治疗前不断发展的组织氧合受损和ECMO治疗期间的神经生理损伤与死亡率相关。它们提供了初步证据，表明应进一步研究ECMO开始的时机与组织氧合恶化的关系，并且cEEG可用于评估对神经损伤和死亡率的潜在影响。
