Abstracts

Rationale: Patients undergoing ECMO have multiple risk factors for neurologic injury and poor neurodevelopmental outcomes. Alterations in cerebral blood flow, use of anticoagulation, and thrombus formation on ECMO tubing can all result in neurologic injuries. Additionally, patients undergoing ECMO cannulation are at increased risk of seizures. EEG correlates with neuroimaging findings after ECMO, but EEG and neuroimaging have not been correlated with long term neurodevelopmental outcomes after ECMO.

Methods: All patients undergoing ECMO cannulation at Children’s Medical Center who are medically stable are placed on continuous video EEG for at least 24 to 48 hours. Post-ECMO neuroimaging is obtained within one month of decannulation and then scored. A developmental assessment is then administered 6 to 12 months after discharge. All EEGs were scored as normal, mild, moderate, or severe based on background encephalopathy, symmetry, and epileptiform abnormalities. Seizures and status epilepticus are noted.

Results: A total of 59 patients had EEG placed per protocol from August 2020 to December 2021. Of these, 1 had a normal EEG, 7 had a mild EEG score, 37 had a moderate EEG score, and 14 had a severe EEG score. As EEG scores became more severe there was a statistically significant lower chance of survival (Figure 1). Seizures were more likely in the group with severe EEG scores compared to the group with moderate EEG scores, with 22% of all patients having seizures captured on EEG. Other neurologic injuries such as hypoxic ischemic events, pupillary changes, and intracranial hemorrhage were noted more with worse EEG scores (Table). A higher percentage of patients with a severe or moderate EEG score used physical therapy 6 to 12 months after discharge, and patients with a severe EEG score were discharged on anti-seizure medications at a higher rate. There were 8 patients with an acute change on EEG, and of these 6 did not survive. EEG score did not correlate with developmental assessments performed 6 to 12 months after discharge. However, patients with normal or mild neuroimaging scores were more likely to score at least average on developmental assessments, while those with severe neuroimaging scores had below or extremely below average scores.

Conclusions: We conclude that severity of EEG findings and acute changes on EEG predict likelihood of survival off ECMO and to discharge. Additionally, moderate and severe EEG findings are associated with neurologic complications on ECMO, specifically an increased risk of seizures with severe EEG scores. A_x000D_ larger data set in the future may show a correlation between EEG and developmental assessments, though neuroimaging abnormalities correlated with worse neurodevelopmental outcomes.

Funding: 2021 ELSO Research Grant