Electroencephalographic Findings Add Prognostic Value to Clinical Features Associated with Mortality on Venoarterial Extracorporeal Support.

IF 3.6 3区医学 Q2 CLINICAL NEUROLOGY

Neurocritical Care Pub Date : 2025-10-01 Epub Date: 2025-04-17 DOI:10.1007/s12028-025-02248-7

Alyson Baker, Ekta Shah, Amy Ouyang, Maya Silver, Stuart R Tomko, Kristin Guilliams, Ahmed S Said, Réjean M Guerriero

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引用次数: 0

Abstract

Background: 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).

Methods: 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.

Results: 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).

Conclusions: 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.

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脑电图结果增加了与静脉体外支持死亡率相关的临床特征的预后价值。

背景：本研究的目的是确定与儿童静脉动脉（V-A）体外膜氧合支持（ECMO）结果相关的临床和连续脑电图（cEEG）变量。方法：我们对2015年1月1日至2020年9月30日接受V-A ECMO的儿科患者进行了回顾性单中心研究。收集了一系列临床和脑电图变量，以评估ecmo前和ecmo后变量与接受脑电图监测的患者住院死亡率的关系。结果：94例接受V-A ECMO的患者有脑电图监测，住院死亡率为43%。在ECMO开始前，非幸存者的pH值明显降低，乳酸水平较高。19例（20%）发生癫痫发作，7例（7%）发展为癫痫持续状态。在患者接受ECMO治疗的前24小时内，不良背景评分和缺乏脑电图变异性或反应性与死亡率相关。一个研究住院死亡率的多变量模型，包括ECMO开始前2小时的pH和乳酸水平、电图癫痫的存在和脑电图不对称作为变量，接受者工作特征曲线下的面积（AUROC）为0.8（95%置信区间[CI] 0.74-0.86, p）。结论：这些数据表明，脑电图测量的ECMO前组织氧合受损和ECMO后神经生理损伤与死亡率之间存在关联。他们提供的初步证据表明，ECMO启动时间与组织氧合恶化有关，应进一步研究，脑电图可用于评估对神经损伤和死亡率的潜在影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurocritical Care 医学-临床神经学

CiteScore

7.40

自引率

8.60%

发文量

221

审稿时长

4-8 weeks

期刊介绍： Neurocritical Care is a peer reviewed scientific publication whose major goal is to disseminate new knowledge on all aspects of acute neurological care. It is directed towards neurosurgeons, neuro-intensivists, neurologists, anesthesiologists, emergency physicians, and critical care nurses treating patients with urgent neurologic disorders. These are conditions that may potentially evolve rapidly and could need immediate medical or surgical intervention. Neurocritical Care provides a comprehensive overview of current developments in intensive care neurology, neurosurgery and neuroanesthesia and includes information about new therapeutic avenues and technological innovations. Neurocritical Care is the official journal of the Neurocritical Care Society.