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Seizures in Children with Cardiac Disease on Extracorporeal Membrane Oxygenation

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Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.

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Funding

This study received no funding.

Author information

Authors and Affiliations

  1. Section of Pediatric Critical Care, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA

    Daniel O. Hassumani

  2. Department of Biostatistics, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA

    Mu Shan

  3. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, 705 Riley Hospital Drive, Phase 2, Room 4900, Indianapolis, IN, 46202-5225, USA

    Christopher W. Mastropietro & Matthew L. Friedman

  4. Division of Pediatric Neurology, Department of Neurology, Indiana University School of Medicine and Riley Hospital for Children At Indiana University Health, Indianapolis, IN, USA

    Sarah E. Wing

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  1. Daniel O. Hassumani
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  2. Mu Shan
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  3. Christopher W. Mastropietro
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  4. Sarah E. Wing
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  5. Matthew L. Friedman
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Contributions

DH and MF were involved in the study design and conception, data collection, data analysis, data interpretation, and drafting of the manuscript. SW and CM were involved in study design and conception, data interpretation, and revising of the manuscript. MS was involved in study design and conception, data analysis, and revising of the manuscript. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Matthew L. Friedman.

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The authors declare that they have no conflicts of interest.

Ethical approval/informed consent

This retrospective study was approved by the institutional review board at Indiana University, and the need for informed consent was waived.

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Hassumani, D.O., Shan, M., Mastropietro, C.W. et al. Seizures in Children with Cardiac Disease on Extracorporeal Membrane Oxygenation. Neurocrit Care 36, 157–163 (2022). https://doi.org/10.1007/s12028-021-01276-3

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  • DOI: https://doi.org/10.1007/s12028-021-01276-3

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