Neurologic complications in neonates supported with extracorporeal membrane oxygenation. An analysis of ELSO registry data

Male Incidence Infant, Newborn Brain injury; Extracorporeal membrane oxygenation; Neonate; Neurologic complications; Critical Care and Intensive Care Medicine 3. Good health Cohort Studies 03 medical and health sciences Extracorporeal Membrane Oxygenation 0302 clinical medicine Odds Ratio Humans Female Registries Nervous System Diseases Retrospective Studies
DOI: 10.1007/s00134-013-2985-x Publication Date: 2013-06-07T14:18:08Z
ABSTRACT
Neurologic complications in neonates supported with extracorporeal membrane oxygenation (ECMO) are common and diminish their quality of life and survival. An understanding of factors associated with neurologic complications in neonatal ECMO is lacking. The goals of this study were to describe the epidemiology and factors associated with neurologic complications in neonatal ECMO.Retrospective cohort study of neonates (age ≤30 days) supported with ECMO using data reported to the Extracorporeal Life Support Organization during 2005-2010.Of 7,190 neonates supported with ECMO, 1,412 (20 %) had neurologic complications. Birth weight <3 kg [odds ratio (OR): 1.3; 95 % confidence intervals (CI): 1.1-1.5], gestational age (<34 weeks; OR 1.5, 95 % CI 1.1-2.0 and 34-36 weeks: OR 1.4, 95 % CI 1.1-1.7), need for cardiopulmonary resuscitation prior to ECMO (OR 1.7, 95 % CI 1.5-2.0), pre-ECMO blood pH ≤ 7.11 (OR 1.7, 95 % CI 1.4-2.1), pre-ECMO bicarbonate use (OR 1.3, 95 % CI 1.2-1.5), prior ECMO exposure (OR 2.4, 95 % CI 1.6-2.6), and use of veno-arterial ECMO (OR 1.7, 95 % CI 1.4-2.0) increased neurologic complications. Mortality was higher in patients with neurologic complications compared to those without (62 % vs. 36 %; p < 0.001).Neurologic complications are common in neonatal ECMO and are associated with increased mortality. Patient factors, pre-ECMO severity of illness, and use of veno-arterial ECMO are associated with increased neurologic complications. Patient selection, early ECMO deployment, and refining ECMO management strategies for vulnerable populations could be targeted as areas for improvement in neonatal ECMO.
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