Variation in electroencephalography and neuroimaging for children receiving extracorporeal membrane oxygenation
Abstract Background Seizures, strokes, and intracranial hemorrhage are common and feared complications in children receiving extracorporeal membrane oxygenation (ECMO) support. Researchers and clinicians have proposed and deployed methods for monitoring and detecting neurologic injury, but best prac...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-01-01
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| Series: | Critical Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13054-022-04293-6 |
| _version_ | 1828056878722056192 |
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| author | Joseph G. Kohne Graeme MacLaren Renée A. Shellhaas Giulia Benedetti Ryan P. Barbaro |
| author_facet | Joseph G. Kohne Graeme MacLaren Renée A. Shellhaas Giulia Benedetti Ryan P. Barbaro |
| author_sort | Joseph G. Kohne |
| collection | DOAJ |
| description | Abstract Background Seizures, strokes, and intracranial hemorrhage are common and feared complications in children receiving extracorporeal membrane oxygenation (ECMO) support. Researchers and clinicians have proposed and deployed methods for monitoring and detecting neurologic injury, but best practices are unknown. We sought to characterize clinicians’ approach to electroencephalography (EEG) and brain imaging modalities in children supported by ECMO. Methods We performed a retrospective observational cohort study among US Children’s Hospitals participating in the Pediatric Health Information System (PHIS) from 2016 to 2021. We identified hospitalizations containing ECMO support. We stratified these admissions by pediatric, neonatal, cardiac surgery, and non-cardiac surgery. We characterized the frequency of EEG, cranial ultrasound, brain computed tomography (CT), magnetic resonance imaging (MRI), and transcranial Doppler during ECMO hospitalizations. We reported key diagnoses (stroke and seizures) and the prescription of antiseizure medication. To assess hospital variation, we created multilevel logistic regression models. Results We identified 8746 ECMO hospitalizations. Nearly all children under 1 year of age (5389/5582) received a cranial ultrasound. Sixty-two percent of the cohort received an EEG, and use increased from 2016 to 2021 (52–72% of hospitalizations). There was marked variation between hospitals in rates of EEG use. Rates of antiseizure medication use (37% of hospitalizations) and seizure diagnoses (20% of hospitalizations) were similar across hospitals, including high and low EEG utilization hospitals. Overall, 37% of the cohort received a CT and 36% received an MRI (46% of neonatal patients). Stroke diagnoses (16% of hospitalizations) were similar between high- and low-MRI utilization hospitals (15% vs 17%, respectively). Transcranial Doppler (TCD) was performed in just 8% of hospitalizations, and 77% of the patients who received a TCD were cared for at one of five centers. Conclusions In this cohort of children at high risk of neurologic injury, there was significant variation in the approach to EEG and neuroimaging in children on ECMO. Despite the variation in monitoring and imaging, diagnoses of seizures and strokes were similar across hospitals. Future work needs to identify a management strategy that appropriately screens and monitors this high-risk population without overuse of resource-intensive modalities. |
| first_indexed | 2024-04-10T21:02:22Z |
| format | Article |
| id | doaj.art-aae115da0ce94568bba0620e8cbe9444 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-04-10T21:02:22Z |
| publishDate | 2023-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-aae115da0ce94568bba0620e8cbe94442023-01-22T12:15:11ZengBMCCritical Care1364-85352023-01-012711810.1186/s13054-022-04293-6Variation in electroencephalography and neuroimaging for children receiving extracorporeal membrane oxygenationJoseph G. Kohne0Graeme MacLaren1Renée A. Shellhaas2Giulia Benedetti3Ryan P. Barbaro4Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of MichiganCardiothoracic Intensive Care Unit, National University Health SystemDivision of Pediatric Neurology, Department of Pediatrics, University of MichiganDepartment of Neurology, Seattle Children’s Hospital and University of WashingtonDivision of Pediatric Critical Care Medicine, Department of Pediatrics, University of MichiganAbstract Background Seizures, strokes, and intracranial hemorrhage are common and feared complications in children receiving extracorporeal membrane oxygenation (ECMO) support. Researchers and clinicians have proposed and deployed methods for monitoring and detecting neurologic injury, but best practices are unknown. We sought to characterize clinicians’ approach to electroencephalography (EEG) and brain imaging modalities in children supported by ECMO. Methods We performed a retrospective observational cohort study among US Children’s Hospitals participating in the Pediatric Health Information System (PHIS) from 2016 to 2021. We identified hospitalizations containing ECMO support. We stratified these admissions by pediatric, neonatal, cardiac surgery, and non-cardiac surgery. We characterized the frequency of EEG, cranial ultrasound, brain computed tomography (CT), magnetic resonance imaging (MRI), and transcranial Doppler during ECMO hospitalizations. We reported key diagnoses (stroke and seizures) and the prescription of antiseizure medication. To assess hospital variation, we created multilevel logistic regression models. Results We identified 8746 ECMO hospitalizations. Nearly all children under 1 year of age (5389/5582) received a cranial ultrasound. Sixty-two percent of the cohort received an EEG, and use increased from 2016 to 2021 (52–72% of hospitalizations). There was marked variation between hospitals in rates of EEG use. Rates of antiseizure medication use (37% of hospitalizations) and seizure diagnoses (20% of hospitalizations) were similar across hospitals, including high and low EEG utilization hospitals. Overall, 37% of the cohort received a CT and 36% received an MRI (46% of neonatal patients). Stroke diagnoses (16% of hospitalizations) were similar between high- and low-MRI utilization hospitals (15% vs 17%, respectively). Transcranial Doppler (TCD) was performed in just 8% of hospitalizations, and 77% of the patients who received a TCD were cared for at one of five centers. Conclusions In this cohort of children at high risk of neurologic injury, there was significant variation in the approach to EEG and neuroimaging in children on ECMO. Despite the variation in monitoring and imaging, diagnoses of seizures and strokes were similar across hospitals. Future work needs to identify a management strategy that appropriately screens and monitors this high-risk population without overuse of resource-intensive modalities.https://doi.org/10.1186/s13054-022-04293-6Extracorporeal membrane oxygenationNeuroimagingSeizuresStrokeBrain injuriesHospitals |
| spellingShingle | Joseph G. Kohne Graeme MacLaren Renée A. Shellhaas Giulia Benedetti Ryan P. Barbaro Variation in electroencephalography and neuroimaging for children receiving extracorporeal membrane oxygenation Critical Care Extracorporeal membrane oxygenation Neuroimaging Seizures Stroke Brain injuries Hospitals |
| title | Variation in electroencephalography and neuroimaging for children receiving extracorporeal membrane oxygenation |
| title_full | Variation in electroencephalography and neuroimaging for children receiving extracorporeal membrane oxygenation |
| title_fullStr | Variation in electroencephalography and neuroimaging for children receiving extracorporeal membrane oxygenation |
| title_full_unstemmed | Variation in electroencephalography and neuroimaging for children receiving extracorporeal membrane oxygenation |
| title_short | Variation in electroencephalography and neuroimaging for children receiving extracorporeal membrane oxygenation |
| title_sort | variation in electroencephalography and neuroimaging for children receiving extracorporeal membrane oxygenation |
| topic | Extracorporeal membrane oxygenation Neuroimaging Seizures Stroke Brain injuries Hospitals |
| url | https://doi.org/10.1186/s13054-022-04293-6 |
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