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Tau Is Elevated in Pediatric Patients on Extracorporeal Membrane Oxygenation

Lee, Amy E.*,†; Pandiyan, Poornima*,†; Liu, Ming-Mei; Williams, Monica A.; Everett, Allen D.§; Mueller, Gregory P.; Morriss, Michael Craig; Raman, Lakshmi*,†; Carlson, Deborah; Gatson, Joshua W.

doi: 10.1097/MAT.0000000000000923
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Neurologic injury is a known and feared complication of extracorporeal membrane oxygenation (ECMO). Neurologic biomarkers may have a role in assisting with early identification of such. Axonal biomarker tau has not been investigated in the pediatric ECMO population. The objective of this study is to evaluate plasma levels tau in pediatric patients supported with ECMO. Eighteen patients requiring ECMO support in a quaternary pediatric intensive care unit at a university-affiliated children’s hospital from October 2015 to February 2017 were enrolled. Patients undergoing extracorporeal cardiopulmonary resuscitation or recent history of bypass were excluded. Plasma tau was measured using enzyme-linked immunosorbent assay. Neuroimaging was reviewed for acute neurologic injury, and tau levels were analyzed to assess for correlation. Tau was significantly higher in ECMO patients than in control subjects. Sixty-one percent of subjects had evidence of acute brain injury on neuroimaging, but tau level did not correlate with injury. Subjects with multifocal injury all experienced infarction and had significantly higher tau levels on ECMO day 3 than patients with isolated injury. In addition, peak tau levels of neuro-injured subjects were compared with controls and noninjured ECMO subjects using receiver operating curve analysis. This study demonstrates preliminary evidence of axonal injury in pediatric ECMO patients.

From the *Children’s Medical Center, Dallas, Texas

Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas

Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland

§Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland

Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, Bethesda, Maryland

Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas.

Submitted for consideration April 2018; accepted for publication in revised form October 2018.

Disclosure: The authors have no conflicts of interest to report.

This study was funded in part from a grant from the Extracorporeal Life Support Organization (ELSO).

Correspondence: Amy E. Lee, Section of Pediatric Critical Care, University of Oklahoma Health Sciences Center, 1200 Everett Drive, CH 8305, Oklahoma City, OK 73104. Email: amy-e-lee@ouhsc.edu.

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