Alyson Baker, Ekta Shah, Amy Ouyang, Maya Silver, Stuart R Tomko, Kristin Guilliams, Ahmed S Said, Réjean M Guerriero
{"title":"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。","authors":"Alyson Baker, Ekta Shah, Amy Ouyang, Maya Silver, Stuart R Tomko, Kristin Guilliams, Ahmed S Said, Réjean M Guerriero","doi":"10.1007/s12028-025-02248-7","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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).</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":19118,"journal":{"name":"Neurocritical Care","volume":" ","pages":"530-540"},"PeriodicalIF":3.6000,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Electroencephalographic Findings Add Prognostic Value to Clinical Features Associated with Mortality on Venoarterial Extracorporeal Support.\",\"authors\":\"Alyson Baker, Ekta Shah, Amy Ouyang, Maya Silver, Stuart R Tomko, Kristin Guilliams, Ahmed S Said, Réjean M Guerriero\",\"doi\":\"10.1007/s12028-025-02248-7\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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).</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>\",\"PeriodicalId\":19118,\"journal\":{\"name\":\"Neurocritical Care\",\"volume\":\" \",\"pages\":\"530-540\"},\"PeriodicalIF\":3.6000,\"publicationDate\":\"2025-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Neurocritical Care\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s12028-025-02248-7\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/4/17 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurocritical Care","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s12028-025-02248-7","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/4/17 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Electroencephalographic Findings Add Prognostic Value to Clinical Features Associated with Mortality on Venoarterial Extracorporeal Support.
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.
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.
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