503 - Identifying High Risk Factors for Neurological Injury in ECMO Patients

Publication Number: 503.5488

Brittany M. Gerald, University of Tennessee Health Science Center College of Medicine, MEMPHIS, TN, United States; Hitesh Sandhu, UTHSC, Memphis, Le Bonheur Children's Hospital, Memphis, TN, United States; Leigh Nevill Adams, Le Bonheur Children's Hospital, Memphis, TN, United States; Christen M. Holder, University of Tennessee Health Science Center College of Medicine, Memphis, TN, United States; Nicolas Chiriboga-Salazar, UTHSC, Memphis, TN, United States

Background: Extracorporeal Membrane Oxygenation (ECMO) is a life-saving therapy for critically ill pediatric and neonatal patients. Neurological injury is a significant complication, impacting morbidity, mortality, and long-term outcomes. Despite this there are only a few articles in the literature discussing neuromonitoring modalities and guidelines.

Objective: We hypothesize that high risk factors will predict neurological injuries on ECMO.

Design/Methods: A retrospective review of all STEP (Standardizing Therapies after ECMO Program) patients (n=26) was conducted. Patients who did not survive to decannulation were excluded (n=1). Nine high-risk factors for developing neurological injury were identified by literature review and clinical experience: age less than 28 days when cannulated, pre-ECMO cardiac arrest, indication for ECMO was heart failure, calculated vasoactive-inotropic score (VIS) greater than 10, pulse pressure less than 20, VA ECMO with carotid artery cannulation, lactate greater than 10, change in paCO2 greater than 30 within 3 hours of cannulation, and neuromuscular blockade.

Results: Preliminary results of the 25 patients included showed that 22 (88%) had one high-risk feature, 20 (80%) had multiple high-risk features, and 13 had neurological insult (52%). Of the patients with high risk factors, 7 (28%) developed intracranial hemorrhage, 6 (24%) had seizures, 5 (20%) had an ischemic injury, and 2 (24%) had generalized edema. Patients without a high-risk factor (n=3), did not have neurological injury. The most common high-risk factors in patients with neurological injury were VA ECMO with carotid cannulation (77%), neuromuscular blockade (54%), VIS greater than 10 (54%), ECMO for heart failure (54%), and age of cannulation less than 28 days (54%).

Conclusion(s): Our findings identified a correlation between high risk factors and subsequent neurological injury. We might be able to predict patients at higher risk of neurological injury during ECMO using the above identified risk factors, and early identification of risk factors might allow us to mitigate neurological injury in ECMO patients.