Continuous Amplitude-Integrated Electroencephalography During Neonatal and Pediatric Extracorporeal Membrane Oxygenation.

Autor:	Chahine A; Pediatric Intensive Care Unit, University Hospital, Toulouse, France., Chenouard A; Pediatric Intensive Care Unit, University Hospital, Nantes, France., Joram N; Pediatric Intensive Care Unit, University Hospital, Nantes, France., Berthomieu L; Pediatric Intensive Care Unit, University Hospital, Toulouse, France., Du Pont-Thibodeau G; Pediatric Intensive Care Unit, Sainte Justine Hospital, Montreal, Canada., Leclere B; Department of Medical Evaluation and Epidemiology, Nantes University Hospital, Nantes, France., Liet JM; Pediatric Intensive Care Unit, University Hospital, Nantes, France., Maminirina P; Congenital Cardiac Surgery, University Hospital, Nantes, France., Leclair-Visonneau L; Electrophysiology Lab and Neurology Department, University Hospital, Nantes, France; and., Breinig S; Pediatric Intensive Care Unit, University Hospital, Toulouse, France., Bourgoin P; Pediatric Intensive Care Unit and Pediatric Cardiac Anesthesia, University Hospital, Nantes, France.
Jazyk:	angličtina
Zdroj:	Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society [J Clin Neurophysiol] 2023 May 01; Vol. 40 (4), pp. 317-324. Date of Electronic Publication: 2021 Aug 09.
DOI:	10.1097/WNP.0000000000000890
Abstrakt:	Purpose: Early prognostication of neurologic outcome in neonates and children supported with extra-corporeal membrane oxygenation (ECMO) is challenging. Amplitude-integrated EEG (aEEG) offers the advantages of continuous monitoring and 24-hours availability at the bedside for intensive care unit providers. The objective of this study was to describe the early electrophysiological background patterns of neonates and children undergoing ECMO and their association with neurologic outcomes. Methods: This was a retrospective review of neonates and children undergoing ECMO and monitored with aEEG. Amplitude-integrated EEG was summarized as an aEEG background score determined within the first 24 hours of ECMO and divided in 3-hour periods. Screening for electrical seizures was performed throughout the full ECMO duration. Neurologic outcome was defined by the Pediatric Cerebral Performance Category score at hospital discharge. Results: Seventy-three patients (median age 79 days [8-660], median weight 4.78 kg [3.24-10.02]) were included in the analysis. Thirty-two patients had a favorable neurologic outcome and 41 had an unfavorable neurologic outcome group at hospital discharge. A 24-hour aEEG background score >17 was associated with an unfavorable outcome with a sensitivity of 44%, a specificity of 97%, a positive predictive value of 95%, and a negative predictive value of 57%. In multivariate analysis, 24-hour aEEG background score was associated with unfavorable outcome (hazard ratio, 6.1; p = 0.001; 95% confidence interval, 2.31-16.24). The presence of seizures was not associated with neurologic outcome at hospital discharge. Conclusions: Continuous aEEG provides accurate neurologic prognostication in neonates and children supported with ECMO. Early aEEG monitoring may help intensive care unit providers to guide clinical care and family counseling. Competing Interests: The authors have no funding or conflicts of interest to disclose. (Copyright © 2021 by the American Clinical Neurophysiology Society.)
Databáze:	MEDLINE
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