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Prevalence of Seizures in Pediatric Extracorporeal Membrane Oxygenation Patients as Measured by Continuous Electroencephalography

Okochi, Shunpei, MD1; Shakoor, Aqsa, MD1; Barton, Sunjay, BS2; Zenilman, Ariela R., MD1; Street, Cherease, BS1; Streltsova, Svetlana, RN, MSN, CCRN3; Cheung, Eva W., MD4; Middlesworth, William, MD1; Bain, Jennifer M., MD, PhD5

doi: 10.1097/PCC.0000000000001730
Neurocritical Care

Objectives: Standards for neuromonitoring during extracorporeal membrane oxygenation support do not currently exist, and there is wide variability in practice. We present our institutional experience at an academic children’s hospital since establishment of a continuous electroencephalography monitoring protocol for extracorporeal membrane oxygenation patients.

Design: Retrospective, single-center study.

Setting: Neonatal ICU and PICU in an urban, quaternary care center.

Patients: All neonatal and pediatric patients requiring extracorporeal membrane oxygenation.

Interventions: None.

Measurements and Main Results: During the study period, 70 patients were cannulated for extracorporeal membrane oxygenation and had continuous electroencephalography monitoring for greater than 24 hours. Electroencephalographic seizures were observed in 16 of 70 patients (23%), including five patients (7%) who were in status epilepticus. Among patients with continuous electroencephalography seizures, nine (56%) had subclinical nonconvulsive status epilepticus and eight (50%) had seizures in the initial 24 hours of extracorporeal membrane oxygenation support. Survival to hospital discharge was significantly greater for extracorporeal membrane oxygenation patients without seizures (74% vs 44%; p = 0.02).

Conclusions: Seizures occur in a significant proportion of pediatric and neonatal extracorporeal membrane oxygenation patients, frequently in the initial 24 hours after extracorporeal membrane oxygenation cannulation. Because seizures are associated with significantly decreased survival, neuromonitoring early in the extracorporeal membrane oxygenation course is important and useful. Further studies are needed to correlate electroencephalography findings with neurologic outcome.

1Department of Surgery, New York - Presbyterian, Columbia University Herbert and Florence Irving Medical Center, New York, NY.

2College of Physicians and Surgeons, New York - Presbyterian, Columbia University Herbert and Florence Irving Medical Center, New York, NY.

3Department of Nursing, New York - Presbyterian, Columbia University Herbert and Florence Irving Medical Center, New York, NY.

4Department of Pediatrics, New York - Presbyterian, Columbia University Herbert and Florence Irving Medical Center, New York, NY.

5Department of Neurology, New York - Presbyterian, Columbia University Herbert and Florence Irving Medical Center, New York, NY.

This work was performed at Columbia University Herbert and Florence Irving Medical Center, Morgan Stanley Children’s Hospital of New York-Presbyterian.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/pccmjournal).

The authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: so2462@cumc.columbia.edu

©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies