Abstracts

Rationale: Single-center studies suggest that up to 30% of pediatric patients on extracorporeal membrane oxygenation (ECMO) have electrographic seizures. The aim of this study was to characterize seizure prevalence and risk factors, brain injury prevalence, and seizure treatment response in the pediatric ECMO population at a tertiary care children’s hospital. Methods: Fifty-two consecutive patients who received Neurology consults while on ECMO were identified from a registry of patients in critical care units over a 2 year period. Forty-seven of these (90%) underwent continuous video-EEG monitoring and were included in the study. A systematic chart review was performed to identify reasons for ECMO initiation, prevalence of electrographic seizures, response to treatment, prevalence of brain injury on neuroimaging, and clinical outcome in this population. Results: Continuous video-EEG was initiated in 37 of 101 infants and children who required ECMO from November 2015 to May 2017 (dates for which complete ECMO registry data were available). Of 49 children who underwent EEG monitoring between November 2015 and March 2018 (two patients were on ECMO twice), 11 patients had seizures (22%). Twenty (41%) were on ECMO post-arrest. Seven post-arrest patients and 4 patients on ECMO for other reasons had seizures. Neonates were significantly more likely to have seizures than other age groups (7/17 neonates and 4/32 non-neonates had seizures; p=0.03, chi-squared test). All 11 patients with seizures had abnormal brain imaging; 8 of these had intracranial hemorrhage. Seizure freedom was achieved in 8/11 (73%) of patients. Twenty-three total patients (47%) died, including 4 of 11 patients with seizures; risk for death was not linked to the presence of electrographic seizures. Conclusions: Neonates on ECMO were more likely to develop seizures than older children. Seizures generally responded well to treatment. However, seizures were usually associated with brain injury, especially intracranial hemorrhage. Further research is needed to determine the relationship between seizures and overall outcome. Clinical practice pathways that include EEG monitoring for children on ECMO should also include neuroimaging and neurodevelopmental follow-up. Funding: This work was supported by the Charles Woodson Pediatric Research Fund at Michigan Medicine.