Routine Neuroimaging: Understanding Brain Injury in Pediatric Extracorporeal Membrane Oxygenation.
Journal
Critical care medicine
ISSN: 1530-0293
Titre abrégé: Crit Care Med
Pays: United States
ID NLM: 0355501
Informations de publication
Date de publication:
01 03 2022
01 03 2022
Historique:
pubmed:
13
10
2021
medline:
11
3
2022
entrez:
12
10
2021
Statut:
ppublish
Résumé
This project aims to describe brain injuries on routine neuroimaging in a large single-center neonatal and pediatric cohort supported by extracorporeal membrane oxygenation. The study also aims to examine the association of these injuries with neurocognitive outcomes in survivors and identify laboratory findings associated with neurologic injury. Retrospective observational single-center cohort study. Tertiary care PICU. Pediatric patients with noncardiac indications for extracorporeal membrane oxygenation supported by venoarterial or venovenous extracorporeal membrane oxygenation, with on-extracorporeal membrane oxygenation brain CT or postextracorporeal membrane oxygenation brain CT/MRI. Extracorporeal membrane oxygenation support. Occurrence of brain injury on CT and MRI was reviewed; injuries were scored. Clinical and laboratory results associated with injury were identified. Survivor neurocognitive outcomes were obtained using the Pediatric Overall Performance Category scale and Pediatric Cerebral Performance Category scale. Of 132 imaged patients, 98 (74%) had radiological evidence of brain injury. Mean injury score was 6.5 (± 3.8). Head ultrasounds and clinician suspicion performed poorly in suspecting the presence of injury. Of 104 respondents to neurodevelopmental assessments, 61 (59%) had normal scores; 12.5%, 17%, and 11.5% had mild, moderate, or severe disability. A neuroimaging score greater than 10 was associated with an unfavorable outcome on the Pediatric Cerebral Performance Category (odds ratio, 3.4; p < 0.01) and Pediatric Overall Performance Category (odds ratio, 1.7; p < 0.05). Ischemic injury correlated with worse neurodevelopmental outcome. Preextracorporeal membrane oxygenation lactate, Vasoactive-Inotropic Scores, transaminitis, elevated bilirubin and creatinine levels, and thrombocytopenia were associated with injury occurrence. Brain injury is frequent in extracorporeal membrane oxygenation patients, although the majority of survivors have favorable neurocognitive outcomes. More research is needed in order to understand the etiology of such injuries. Head ultrasound and clinician suspicion are not sensitive in detecting extracorporeal membrane oxygenation-related brain injuries. Protocolizing postextracorporeal membrane oxygenation imaging with brain MRI allows the identification of injuries and provision of timely neurocognitive intervention.
Identifiants
pubmed: 34637418
doi: 10.1097/CCM.0000000000005308
pii: 00003246-202203000-00013
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
480-490Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Déclaration de conflit d'intérêts
Dr. Farhat received funding from Children’s Health through the Children’s Clinical Research Advisory Council Fellow Award and the National Center for Advancing Translational Sciences (UL1TR001105); he received support for article research from the National Institutes of Health. Dr. Li disclosed work for hire. The remaining authors have disclosed that they do not have any potential conflicts of interest.
Références
Extracorporeal Life Support Organization: ECMO and ECLS > Registry > Statistics > International Summary. 2021. Available at: https://www.elso.org/Registry/Statistics/InternationalSummary.aspx . Accessed October 27, 2020
Jenks CL, Raman L, Dalton HJ: Pediatric extracorporeal membrane oxygenation. Crit Care Clin. 2017; 33:825–841
Bulas D, Glass P: Neonatal ECMO: Neuroimaging and neurodevelopmental outcome. Semin Perinatol. 2005; 29:58–65
Rehder KJ, Turner DA, Cheifetz IM: Extracorporeal membrane oxygenation for neonatal and pediatric respiratory failure: An evidence-based review of the past decade (2002-2012). Pediatr Crit Care Med. 2013; 14:851–861
Mehta T, Sallehuddin A, John J: The journey of pediatric ECMO. Qatar Med J. 2017; 2017:4
Polito A, Barrett CS, Wypij D, et al.: Neurologic complications in neonates supported with extracorporeal membrane oxygenation. An analysis of ELSO Registry data. Intensive Care Med. 2013; 39:1594–1601
Boyle K, Felling R, Yiu A, et al.: Neurologic outcomes after extracorporeal membrane oxygenation: A systematic review. Pediatr Crit Care Med. 2018; 19:760–766
Bembea MM, Felling RJ, Caprarola SD, et al.: Neurologic outcomes in a two-center cohort of neonatal and pediatric patients supported on extracorporeal membrane oxygenation. ASAIO J. 2019; 66:79–88
Madderom MJ, Reuser JJ, Utens EM, et al.: Neurodevelopmental, educational and behavioral outcome at 8 years after neonatal ECMO: A nationwide multicenter study. Intensive Care Med. 2013; 39:1584–1593
Waitzer E, Riley SP, Perreault T, et al.: Neurologic outcome at school entry for newborns treated with extracorporeal membrane oxygenation for noncardiac indications. J Child Neurol. 2009; 24:801–806
Lorusso R, Gelsomino S, Parise O, et al.: Neurologic injury in adults supported with veno-venous extracorporeal membrane oxygenation for respiratory failure: Findings from the extracorporeal life support organization database. Crit Care Med. 2017; 45:1389–1397
Wien MA, Whitehead MT, Bulas D, et al.: Patterns of brain injury in newborns treated with extracorporeal membrane oxygenation. AJNR Am J Neuroradiol. 2017; 38:820–826
van Heijst AF, de Mol AC, Ijsselstijn H: ECMO in neonates: Neuroimaging findings and outcome. Semin Perinatol. 2014; 38:104–113
Pinto VL, Pruthi S, Westrick AC, et al.: Brain magnetic resonance imaging findings in pediatric patients post extracorporeal membrane oxygenation. ASAIO J. 2017; 63:810–814
Anton-Martin P, Raman L, Thatte N, et al.: Pre-ECMO coagulopathy does not increase the occurrence of hemorrhage during extracorporeal support. Int J Artif Organs. 2017; 40:250–255
Lorusso R, Vizzardi E, Pinelli L, et al.: Posterior reversible encephalopathy syndrome in a patient submitted to extracorporeal membrane oxygenation for acute fulminant myocarditis. Int J Cardiol. 2014; 172:e329–e330
Muellenbach RM, Kilgenstein C, Kranke P, et al.: Effects of venovenous extracorporeal membrane oxygenation on cerebral oxygenation in hypercapnic ARDS. Perfusion. 2014; 29:139–141
Kredel M, Lubnow M, Westermaier T, et al.: Cerebral tissue oxygenation during the initiation of venovenous ECMO. ASAIO J. 2014; 60:694–700
Hardart GE, Fackler JC: Predictors of intracranial hemorrhage during neonatal extracorporeal membrane oxygenation. J Pediatr. 1999; 134:156–159
Kolodziej A, Burchett A, Tribble T, et al.: Lactic acid is the most important factor predicting survival on VA ECMO. J Heart Lung Transplant. 2017; 36:S347
Park SJ, Kim SP, Kim JB, et al.: Blood lactate level during extracorporeal life support as a surrogate marker for survival. J Thorac Cardiovasc Surg. 2014; 148:714–720
Lorusso R: Extracorporeal life support and neurologic complications: Still a long way to go. J Thorac Dis. 2017; 9:E954–E956
Sznycer-Taub NR, Lowery R, Yu S, et al.: Hyperoxia is associated with poor outcomes in pediatric cardiac patients supported on venoarterial extracorporeal membrane oxygenation. Pediatr Crit Care Med. 2016; 17:350–358
Fletcher-Sandersjöö A, Bartek J Jr, Thelin EP, et al.: Predictors of intracranial hemorrhage in adult patients on extracorporeal membrane oxygenation: An observational cohort study. J Intensive Care. 2017; 5:27
Fletcher-Sandersjöö A, Thelin EP, Bartek J Jr, et al.: Incidence, outcome, and predictors of intracranial hemorrhage in adult patients on extracorporeal membrane oxygenation: A systematic and narrative review. Front Neurol. 2018; 9:548
Taylor GA, Fitz CR, Miller MK, et al.: Intracranial abnormalities in infants treated with extracorporeal membrane oxygenation: Imaging with US and CT. Radiology. 1987; 165:675–678
Taylor GA, Glass P, Fitz CR, et al.: Neurologic status in infants treated with extracorporeal membrane oxygenation: Correlation of imaging findings with developmental outcome. Radiology. 1987; 165:679–682
McIntosh AM, Tong S, Deakyne SJ, et al.: Validation of the vasoactive-inotropic score in pediatric sepsis. Pediatr Crit Care Med. 2017; 18:750–757
Fiser DH, Long N, Roberson PK, et al.: Relationship of pediatric overall performance category and pediatric cerebral performance category scores at pediatric intensive care unit discharge with outcome measures collected at hospital discharge and 1- and 6-month follow-up assessments. Crit Care Med. 2000; 28:2616–2620
McHugh ML: Interrater reliability: The kappa statistic. Biochem Med (Zagreb). 2012; 22:276–282
Cohen J: A coefficient of agreement for nominal scales. Educ Psychol Meas. 1960; 20:37–46
Hunt RW, Kean MJ, Stewart MJ, et al.: Patterns of cerebral injury in a series of infants with congenital diaphragmatic hernia utilizing magnetic resonance imaging. J Pediatr Surg. 2004; 39:31–36
Tracy S, Estroff J, Valim C, et al.: Abnormal neuroimaging and neurodevelopmental findings in a cohort of antenatally diagnosed congenital diaphragmatic hernia survivors. J Pediatr Surg. 2010; 45:958–965
McCutcheon KC, Wise L, Lewis K, et al.: The utility of cranial ultrasound as a screening tool for neonatal ECMO. J Perinat Med. 2020; 48:173–178
Rollins MD, Yoder BA, Moore KR, et al.: Utility of neuroradiographic imaging in predicting outcomes after neonatal extracorporeal membrane oxygenation. J Pediatr Surg. 2012; 47:76–80
Tian F, Morriss MC, Chalak L, et al.: Impairment of cerebral autoregulation in pediatric extracorporeal membrane oxygenation associated with neuroimaging abnormalities. Neurophotonics. 2017; 4:041410
Bulas DI, Glass P, O’Donnell RM, et al.: Neonates treated with ECMO: Predictive value of early CT and US neuroimaging findings on short-term neurodevelopmental outcome. Radiology. 1995; 195:407–412
Kazmi SO, Sivakumar S, Karakitsos D, et al.: Cerebral pathophysiology in extracorporeal membrane oxygenation: Pitfalls in daily clinical management. Crit Care Res Pract. 2018; 2018:3237810
Cavayas YA, Munshi L, Del Sorbo L, et al.: The early change in PaCO 2 after extracorporeal membrane oxygenation initiation is associated with neurological complications. Am J Respir Crit Care Med. 2020; 201:1525–1535
Joram N, Beqiri E, Pezzato S, et al.: Impact of arterial carbon dioxide and oxygen content on cerebral autoregulation monitoring among children supported by ECMO [Internet]. Neurocrit Care. 2021 Mar 9. [online ahead of print]
Bladowski M, Gawrys J, Gajecki D, et al.: Role of the platelets and nitric oxide biotransformation in ischemic stroke: A translative review from bench to bedside. Oxid Med Cell Longev. 2020; 2020:2979260
Reed RC, Rutledge JC: Laboratory and clinical predictors of thrombosis and hemorrhage in 29 pediatric extracorporeal membrane oxygenation nonsurvivors. Pediatr Dev Pathol. 2010; 13:385–392
Pappalardo F, Montisci A: Neurologic complications during V-V extracorporeal membrane oxygenation: Still counting…. J Thorac Dis. 2017; 9:2774–2776
Sparrow SS, Balla DA, Cicchetti DV, et al.: Vineland Adaptive Behavior Scales. Circle Pines, MN, American Guidance Service, Inc, 1984
Singh A, Yeh CJ, Boone Blanchard S: Ages and stages questionnaire: A global screening scale. Bol Med Hosp Infant Mex. 2017; 74:5–12