Authors :
Presenting Author: Zaloa Agirre-Arrizubieta, MD – Paediatric Clinical Neurophysiology, Evelina London Children’s Hospital, Guy’s & St Thomas’ NHS Foundation Trust
Matthew Sparkes, BS – Paediatric Clinical Neurophysiology, Evelina London Children’s Hospital, Guy’s & St Thomas’ NHS Foundation Trust
Jonathan Lillie, MD – Paediatric Intensive Care Unit, Evelina London Children’s Hospital
Sushma Goyal, MD – Paediatric Clinical Neurophysiology, Evelina London Children’s Hospital, Guy’s & St Thomas’ NHS Foundation Trust
Tomoki Arichi, MD, PhD – Department of Early Life Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London
Rationale: In the neonatal and infant period, seizures are one of the most common neurological emergencies. ECMO is used to support neonates and infants with refractory cardiac / respiratory failure. EEG is used to analyse emergence of seizures, background rhythms and presence of physiological features.
The aim of this study is to assess the correlation of aetiology of the disease, acute seizures, background rhythms, physiological features and survival rate at hospital discharge in neonates and infants undergoing EEG-ECMO.
Methods: This is a retrospective study involving 53 neonates and infants during a 5-year period. The paediatric EEG and paediatric intensive care unit databases were used to collect data. Aetiology of disease is noted. Duration of EEG is studied. EEG features, such as, background according to age, presence of physiological sleep phenomena, brain reactivity and emergence of seizures are described. Survival rate at hospital discharge is analysed in relation to EEG features and aetiology of the disease.
Results: The most common aetiology referred for EEG-ECMO is cardiology related, 70%. Duration of EEG is of >1hour in ~70%.
Regarding EEG features, normal background rhythms are seen in 9%, correlating with 100% survival rate at hospital discharge. Abnormal background rhythms, i.e., asymmetric / diffusely slow are seen in 91%. Within an abnormal background, physiological features, such as, brain reactivity, sleep phenomena and or temporo-spatial organisation are present in 63%, achieving a survival rate of 90% at discharge. Mortality is seen in all children with abnormal background and absence of temporo-spatial organisation, severely attenuated rhythms or burst-suppression. Acute seizures are seen in 25%. Seizures are focal and electrographic only in all children monitored. Ictal onset starting from the posterior regions is seen in 77% and from the anterior-central regions in 23%. All seizures are associated with brain structural lesion in neuro-imaging. When acute seizures are seen within background rhythms with brain reactivity, sleep phenomena and or some temporo spatial organisation, survival rate of 30% is noted.
Conclusions: In our study, acute seizures are seen in ¼ of the neonates and infants undergoing EEG-ECMO, similar to data described in the literature. Acute seizures in neonates and infants undergoing EEG-ECMO are a high-risk factor; however, when background rhythms present with brain reactivity, sleep phenomena and or some temporo-spatial organisation, survival rates of 30% can be achieved. Background rhythms and presence of physiological features are associated with the aetiology of the disease and can provide guidance regarding clinical management in neonates and infants undergoing EEG-ECMO.
Tsuchida TN, Wusthoff CJ, Shellhaas RA, et al.
American Clinical Neurophysiology Society Standardized EEG Terminology and Categorization for the Description of Continuous EEG Monitoring in Neonates. J Clin Neurophysiol. 2013;30(2):161-73.
Sansevere AJ, DiBacco ML, Akhondi-Asl A, et al.
EEG features of brain injury during extracorporeal membrane oxygenation in children. Neurology. 2020;95(10):e1372-e1380.
Funding: No funding.