Objectives: 

To evaluate the risk factors for mortality in pediatric extracorporeal membrane oxygenation patients.

Design: 

Retrospective, single-center study.

Setting: 

PICU and Pediatric cardiothoracic ICU in an urban, quaternary care center.

Patients: 

All neonatal and pediatric patients requiring extracorporeal membrane oxygenation at our institution between January 2014 and December 2018, who underwent a standardized continuous electroencephalogram neuromonitoring protocol during most of the duration of extracorporeal membrane oxygenation support. We excluded patients who had extracorporeal membrane oxygenation initiated at another institution.

Intervention: 

None.

Measurements and Main Results: 

Sixty-six children required extracorporeal membrane oxygenation support during this period. Four patients were excluded, three due to lack of electroencephalogram data, one with extracorporeal membrane oxygenation initiated at other institution. In the remaining 62, 11 patients (17%) had seizures, of which 5 (45%) had status epilepticus. Eight of 11 patients (72%) had exclusively electrographic seizures. A total of 33 patients (53.2%) died, of which 22 died during extracorporeal membrane oxygenation course, and one died 3 years after hospital discharge. Mean survival from extracorporeal membrane oxygenation initiation was 766.9 days (standard deviation, 691.7; median, 546.5; interquartile range 1–3, 97.7–1255.0). In multivariate analysis, increased risk of mortality was associated with the use of extracorporeal cardiopulmonary resuscitation (hazard ratio, 4.33; 95% CI, 1.75–10.72; p = 0.002), imaging findings of cerebral edema (hazard ratio, 14.31; 95% CI, 5.18–39.54; p < 0.001), high lactate level (> 100 mg/dL within 2 hr preextracorporeal membrane oxygenation) (hazard ratio, 1.22; 95% CI, 1.03–1.44; p = 0.022), and prolonged deep hypothermic circulatory arrest (hazard ratio, 3.43; 95% CI, 1.65–7.13; p < 0.001). Presence of seizures was associated with imaging findings of cerebral edema (hazard ratio, 4.16; 95% CI, 1.04–16.58; p = 0.04).

Conclusions: 

Seizures are common in children requiring extracorporeal membrane oxygenation support, with a high rate of electrographic seizures and status epilepticus, as in prior studies. Presence of cerebral edema is both risk factor for mortality and seizures. Other risk factors for mortality include extracorporeal cardiopulmonary resuscitation, high lactate levels, and prolonged deep hypothermic circulatory arrest.

中文翻译：

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小儿体外膜氧合患者连续队列的癫痫发作率和死亡率危险因素

目标： 

评估小儿体外膜氧合患者死亡的危险因素。

设计： 

回顾性单中心研究。

设置： 

在城市四级护理中心就诊PICU和儿科心胸ICU。

耐心： 

2014年1月至2018年12月期间，我们机构内所有需要体外膜氧合的新生儿和小儿患者，在体外膜氧合支持的大部分期间均接受了标准化的连续脑电图神经监测方案。我们排除了在另一家机构开始进行体外膜氧合的患者。

介入： 

没有。

测量和主要结果： 

在此期间，有66名儿童需要体外膜氧合作用。排除了4例患者，其中3例由于缺乏脑电图数据，其中1例在其他机构开始进行体外膜氧合。在其余的62名患者中，有11名（17％）癫痫发作，其中5名（45％）具有癫痫持续状态。11例患者中有8例（72％）仅因电图发作。共有33例患者（53.2％）死亡，其中22例在体外膜氧合过程中死亡，一例在出院3年后死亡。体外膜氧合开始的平均生存期为766.9天（标准差为691.7；中位数为546.5；四分位范围为1-3，为97.7-1255.0）。在多变量分析中，死亡率增加与体外心肺复苏的使用相关（危险比，4.33； 95％CI，1.75–10.72；p = 0.002），脑水肿的影像学表现（危险比，14.31； 95％CI） ，5.18–39.54；p <0.001），高乳酸水平（体外膜前充氧2小时内> 100 mg / dL）（危险比，1.22； 95％CI，1.03–1.44；p= 0.022），并延长了深低温循环的停止时间（危险比，3.43； 95％CI，1.65-7.13；p <0.001）。的存在癫痫发作与脑水肿的影像表现相关联（风险比，4.16; 95％CI，1.04-16.58; p = 0.04）。

结论： 

像以前的研究一样，癫痫发作常见于需要体外膜氧合支持的儿童，其电图发作和癫痫持续状态的发生率很高。脑水肿的存在既是死亡和癫痫发作的危险因素。死亡的其他危险因素包括体外心肺复苏，高乳酸水平和长时间的深低温循环停止。