Kalpana Singh, MD
Riley Hospital for Children, Indianapolis
Indianapolis, Indiana
Disclosure information not submitted.
Mouhammad Yabrodi, MD
Associate Professor of Clinical Pediatrics
Riley Hospital for Children, United States
Disclosure information not submitted.
Matthew Friedman, MD,MS
Associate Professor of Clinical Pediatrics
Riley Hospital for Children, United States
Disclosure information not submitted.
Christopher Mastropietro, MD, FCCM
Professor of Clinical Pediatrics
Riley Hospital for Children, United States
Disclosure information not submitted.
Title: Risk Factors for Seizures in Children on Cardiac ECMO
Introduction: Cardiac Extracorporeal Membrane Oxygenation (ECMO) is known to be associated with risk of neurologic injury. The goal of this study is to establish the risk factors associated with seizures in neonatal and pediatric cardiac ECMO population.
Methods: The data for seizures, demographic and ECMO variables and clinical complications were obtained from Extracorporeal Life support Organization (ELSO) registry for 2015-2019. Univariate analysis using Student’s t-test was done for continuous variables and Chi-square test for categorical variables. A multivariate analysis was conducted on univariate variables with p value < 0.05.
Results: Total 10 518 cardiac ECMO patients were reported during 2015-2019. There were 1093 (32%) premature patients in our study population. The incidence of seizures was 1574 (7.48%). Patients with seizures on ECMO were younger and had lower weight (p < 0.0001). Prematurity reduced the risk of seizures (OR 0.7, p=0.01). Factors associated with increased risk of seizures were diagnosis of Hypoplastic left heart syndrome and Tetralogy of Fallot (OR 1.4; OR 1.5; p=0.002), Norwood and BT shunt procedure (OR 1.4, p=0.008; OR 1.6, p< 0.017), pre-ECMO worse acidosis, hypercarbia and hypoxemia (p< 0.0001), pre-ECMO cardiac arrest (OR 2.1, p< 0.0001), ECPR (OR 2.4, p< 0.0001), carotid and jugular VA-ECMO (OR 1.9; OR 1.6; p< 0.0001) and cooling interventions (OR 2, p< 0.001). The factors associated with reduced risk of seizures were heart transplant and ventricular assist device (OR 0.5, p=0.01; OR 0.4, p=0.009), and femoral VA-ECMO (OR 0.3, OR 0.4; p< 0.0001) . Seizure group had increased risk of mortality (OR 2.1, p< 0.0001). The risk of seizures was similar in repeat ECMO group compared to single ECMO run group (OR 1, p=0.74). Multivariate analysis reported age, hypercarbia, pre-ECLS arrest, Norwood, carotid and intrajugular cannulation, hypoxemia and ECPR as independent risk factors for seizures in cardiac ECMO patients. Heart transplant and femoral arterial cannulation are independently associated with reduced risk of seizures.
Conclusion: Despite a lifesaving modality, ECMO is associated with increased risk of seizures in cardiac ECMO patients. Understanding the risk factors associated with seizures in children on cardiac ECMO may assist in improved monitoring and management.