148 - Head Ultrasound Findings and Associated Outcomes of Infants on Extracorporeal Membrane Oxygenation

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 148
Publication Number: 148.135

Pratishtha Panigrahi, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Arastoo Vossough, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Maryam Naim, Childrens Hospital of Philadelphia/University of Pennsylvania, Philadelphia, PA, United States; Gnana Dheepa. Ardhanari, Children's Memorial Hermann Hospital, Pearland, TX, United States; Nicholas S. Abend, Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, United States; Shavonne Massey, Childrens Hospital of Philadelphia, Philadelphia, PA, United States

Presenting Author(s)

Pratishtha Panigrahi, BS (she/her/hers)

Clinical Research Coordinator
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States

Background: Extracorporeal membrane oxygenation (ECMO) is a life-saving intervention to support infants with severe cardiac and/or pulmonary disease, however exposure to ECMO can result in injury to the central nervous system that has been associated with poor outcomes.

Objective: To assess head ultrasound (HUS) findings and associated outcomes in infants exposed to ECMO.

Design/Methods:

A prospective observational study assessed all patients undergoing ECMO from 2012-2019, including concurrent continuous electroencephalogram (EEG) monitoring data. We retrospectively assessed all infants (< 12 months) with a HUS during the first ECMO run. Reports from HUS studies interpreted by pediatric radiologists and EEG studies reported by pediatric electroencephalographers were reviewed. Counts (percentage) and medians (interquartile range) were used for descriptive statistics while Fishers exact test and Wilcoxon rank sum were used for tests of association.

Results: Data from 227 patients were analyzed, including 30 patients (13%) with electrographic seizures. HUS was abnormal for 126 patients (56%) and the most common findings were abnormal echogenicity (53%), hemorrhage (27% [79% intraventricular, 21% parenchymal]), and enlarged extra-axial spaces (25%). An abnormal HUS was more common in patients managed with VA ECMO compared to VV ECMO (p=0.02) and in patients who experienced complications while on ECMO (p< 0.01). The presence of an abnormal HUS was not associated with electrographic seizures (p=0.06), seizure burden (p=0.25), seizure type (p=1.00), EEG background at onset (p=0.12) or end of the monitoring period (p=0.30), or an abnormal neurologic exam at discharge (p=0.16). The presence of an abnormal HUS was associated with in-hospital mortality (p< 0.01), feeding status at discharge (p=0.03), respiratory status at discharge (p< 0.01), and continued use of antiseizure medications (ASM) at discharge (p=0.02).

Conclusion(s): Abnormal HUS findings occurred in the majority of infants on ECMO and were associated with poor acute outcomes, including death and the ongoing need for feeding and respiratory support. While the presence of abnormal HUS findings was not associated with an abnormal EEG background or an increased risk of seizures, patients with abnormal HUS findings who experienced seizures were more likely to be discharged on an ASM. The presence of abnormal HUS findings can help identify infants at risk for poor acute outcomes, but further study is needed to define how specific HUS abnormalities can be incorporated in multimodal analysis for individualized prognostication.