Neurological Monitoring and Complications of Pediatric Extracorporeal Membrane Oxygenation Support

Ahmed S. Said, Kristin P. Guilliams, Melania M. Bembea

Research output: Contribution to journalReview articlepeer-review

Abstract

Extracorporeal membrane oxygenation is extracorporeal life support for life-threatening cardiopulmonary failure. Since its introduction, the use of extracorporeal membrane oxygenation has expanded to patients with more complex comorbidities without change in patient mortality rates. Although many patients survive, significant neurological complications like seizures, ischemic strokes, and intracranial hemorrhage can occur during extracorporeal membrane oxygenation care. The risks of these complications often add to the complexity of decision-making surrounding extracorporeal membrane oxygenation support. In this review, we discuss the pathophysiology and incidence of neurological complications in children supported on extracorporeal membrane oxygenation, factors influencing the incidence of these complications, commonly used neurological monitoring modalities, and outcomes for this complex patient population. We discuss the current literature on the use of electroencephalography for both seizure detection and monitoring of background electroencephalographic changes, in addition to the use of less commonly used imaging modalities like transcranial Doppler. We summarize the knowledge gaps and the lack of clinical consensus guidelines for managing these potentially life-changing neurological complications. Finally, we discuss future work to further understand the pathophysiology of extracorporeal membrane oxygenation-related neurological complications.

Original languageEnglish (US)
Pages (from-to)31-39
Number of pages9
JournalPediatric Neurology
Volume108
DOIs
StatePublished - Jul 2020

Keywords

  • Electroencephalography
  • Extracorporeal membrane oxygenation
  • Intracranial hemorrhage
  • Seizures
  • Stroke

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Neurology
  • Developmental Neuroscience
  • Clinical Neurology

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