Yıl: 2022 Cilt: 64 Sayı: 5 Sayfa Aralığı: 882 - 891 Metin Dili: İngilizce DOI: 10.24953/turkjped.2022.323 İndeks Tarihi: 15-12-2022

Imaging spectrum of extracorporeal membrane oxygenation related neurologic events in children

Öz:
Background. Extracorporeal membrane oxygenation (ECMO) can be associated with severe neurological complications increasing morbidity and mortality. We aimed to evaluate imaging findings in patients with neurological complications associated with ECMO. Methods. Children (<18 years) who had ECMO support and received cross-sectional imaging (cranial CT and/ or MRI) were retrospectively evaluated. Age, gender, clinical and imaging findings were documented and the relation to ECMO duration and survival rates with imaging findings and imaging time (during ECMO or after weaning) were examined. Results. Twenty children who had cranial CT/MRI during (n=6) ECMO and after weaning (n=14) were included in the study. The median duration of ECMO was 12.5 days (IQR=5-25 days) with a survival rate of 65%. Fourteen patients had positive imaging findings including ischemic stroke (n=4), hemorrhagic stroke (n=4), hypoxicischemic encephalopathy (n=2), posterior reversible encephalopathy syndrome (PRES) (n=3) and cerebral vein thrombosis (n=1). The duration of ECMO and survival rates did not significantly differ between patients with positive and unremarkable imaging findings. However, the survival rate was significantly higher (p<0.001) and the duration of ECMO was significantly lower in patients scanned after weaning compared to patients imaged during ECMO support (p=0.033). Conclusions. Our series revealed PRES in ECMO-related neurologic events in addition to commonly reported thrombotic and hemorrhagic stroke in the literature. Availability of cross-sectional imaging and awareness of radiologists to these complications during ECMO or after weaning help in prompt diagnosis and treatment.
Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • 1. Hill JD, O’Brien TG, Murray JJ, et al. Prolonged extracorporeal oxygenation for acute post-traumatic respiratory failure (shock-lung syndrome). Use of the Bramson membrane lung. N Engl J Med 1972; 286: 629-634. https://doi.org/10.1056/ NEJM197203232861204
  • 2. Bartlett RH, Gazzaniga AB, Jefferies MR, Huxtable RF, Haiduc NJ, Fong SW. Extracorporeal membrane oxygenation (ECMO) cardiopulmonary support in infancy. Trans Am Soc Artif Intern Organs 1976; 22: 80-93.
  • 3. Barbaro RP, Paden ML, Guner YS, et al. Pediatric Extracorporeal Life Support Organization Registry International Report 2016. ASAIO J 2017; 63: 456-463. https://doi.org/10.1097/MAT.0000000000000603
  • 4. Said AS, Guilliams KP, Bembea MM. Neurological monitoring and complications of pediatric extracorporeal membrane oxygenation support. Pediatr Neurol 2020; 108: 31-39. https://doi. org/10.1016/j.pediatrneurol.2020.03.014
  • 5. Bembea MM, Felling RJ, Caprarola SD, et al. Neurologic outcomes in a two-center cohort of neonatal and pediatric patients supported on extracorporeal membrane oxygenation. ASAIO J 2020; 66: 79-88. https://doi.org/10.1097/ MAT.0000000000000933
  • 6. Cashen K, Reeder R, Dalton HJ, et al. Functional status of neonatal and pediatric patients after extracorporeal membrane oxygenation. Pediatr Crit Care Med 2017; 18: 561-570. https://doi.org/10.1097/ PCC.0000000000001155
  • 7. Di Gennaro JL, Chan T, Farris RWD, Weiss NS, McMullan DM. Increased stroke risk in children and young adults on extracorporeal life support with carotid cannulation. ASAIO J 2019; 65: 718-724. https://doi.org/10.1097/MAT.0000000000000912
  • 8. Cengiz P, Seidel K, Rycus PT, Brogan TV, Roberts JS. Central nervous system complications during pediatric extracorporeal life support: incidence and risk factors. Crit Care Med 2005; 33: 2817-2824. https://doi.org/10.1097/01.ccm.0000189940.70617.c3
  • 9. Teele SA, Salvin JW, Barrett CS, et al. The association of carotid artery cannulation and neurologic injury in pediatric patients supported with venoarterial extracorporeal membrane oxygenation*. Pediatr Crit Care Med 2014; 15: 355-361. https://doi.org/10.1097/ PCC.0000000000000103
  • 10. Polito A, Barrett CS, Wypij D, et al. Neurologic complications in neonates supported with extracorporeal membrane oxygenation. An analysis of ELSO registry data. Intensive Care Med 2013; 39: 1594-1601. https://doi.org/10.1007/s00134-013-2985-x
  • 11. Pinto VL, Pruthi S, Westrick AC, Shannon CN, Bridges BC, Le TM. Brain magnetic resonance imaging findings in pediatric patients post extracorporeal membrane oxygenation. ASAIO J 2017; 63: 810-814. https://doi.org/10.1097/MAT.0000000000000580
  • 12. Okochi S, Shakoor A, Barton S, et al. Prevalence of seizures in pediatric extracorporeal membrane oxygenation patients as measured by continuous electroencephalography. Pediatr Crit Care Med 2018; 19: 1162-1167. https://doi.org/10.1097/ PCC.0000000000001730
  • 13. Hardart GE, Fackler JC. Predictors of intracranial hemorrhage during neonatal extracorporeal membrane oxygenation. J Pediatr 1999; 134: 156-159. https://doi.org/10.1016/s0022-3476(99)70408-7
  • 14. von Kummer R, Broderick JP, Campbell BCV, et al. The Heidelberg Bleeding Classification: classification of bleeding events after ischemic stroke and reperfusion therapy. Stroke 2015; 46: 2981-2986. https://doi.org/10.1161/STROKEAHA.115.010049
  • 15. Besser MW, Klein AA. The coagulopathy of cardiopulmonary bypass. Crit Rev Clin Lab Sci 2010; 47: 197-212. https://doi.org/10.3109/10408363.2010.54 9291
  • 16. Lo B, Fijnheer R, Castigliego D, Borst C, Kalkman CJ, Nierich AP. Activation of hemostasis after coronary artery bypass grafting with or without cardiopulmonary bypass. Anesth Analg 2004; 99: 634-640. https://doi.org/10.1213/01. ANE.0000130257.64006.5C
  • 17. Millar JE, Fanning JP, McDonald CI, McAuley DF, Fraser JF. The inflammatory response to extracorporeal membrane oxygenation (ECMO): a review of the pathophysiology. Crit Care 2016; 20: 387. https://doi.org/10.1186/s13054-016-1570-4
  • 18. Da Q, Teruya M, Guchhait P, Teruya J, Olson JS, Cruz MA. Free hemoglobin increases von Willebrand factor-mediated platelet adhesion in vitro: implications for circulatory devices. Blood 2015; 126: 2338-2341. https://doi.org/10.1182/ blood-2015-05-648030
  • 19. Extracorporeal Life Support Organization. International Complication Trend Report. Ann Arbor, MI Extracorpor Life Support Organ, 2020: 1-159.
  • 20. Luyt C-E, Bréchot N, Demondion P, et al. Brain injury during venovenous extracorporeal membrane oxygenation. Intensive Care Med 2016; 42: 897-907. https://doi.org/10.1007/s00134-016-4318-3
  • 21. Lorusso R, Barili F, Mauro MD, et al. In-hospital neurologic complications in adult patients undergoing venoarterial extracorporeal membrane oxygenation: results from the Extracorporeal Life Support Organization registry. Crit Care Med 2016; 44: e964-72. https://doi.org/10.1097/ CCM.0000000000001865
  • 22. Lockie CJA, Gillon SA, Barrett NA, et al. Severe respiratory failure, extracorporeal membrane oxygenation, and intracranial hemorrhage. Crit Care Med 2017; 45: 1642-1649. https://doi.org/10.1097/ CCM.0000000000002579
  • 23. Tian F, Morriss MC, Chalak L, et al. Impairment of cerebral autoregulation in pediatric extracorporeal membrane oxygenation associated with neuroimaging abnormalities. Neurophotonics 2017; 4: 041410. https://doi.org/10.1117/1.NPh.4.4.041410
  • 24. Tweed A, Cote J, Lou H, Gregory G, Wade J. Impairment of cerebral blood flow autoregulation in the newborn lamb by hypoxia. Pediatr Res 1986; 20: 516-519. https://doi.org/10.1203/00006450- 198606000-00007
  • 25. Short BL, Walker LK, Traystman RJ. Impaired cerebral autoregulation in the newborn lamb during recovery from severe, prolonged hypoxia, combined with carotid artery and jugular vein ligation. Crit Care Med 1994; 22: 1262-1268. https:// doi.org/10.1097/00003246-199408000-00010
  • 26. Short BL. The effect of extracorporeal life support on the brain: a focus on ECMO. Semin Perinatol 2005; 29: 45-50. https://doi.org/10.1053/j.semperi.2005.02.007
  • 27. Kazmi SO, Sivakumar S, Karakitsos D, Alharthy A, Lazaridis C. Cerebral pathophysiology in extracorporeal membrane oxygenation: pitfalls in daily clinical management. Crit Care Res Pract 2018; 2018: 3237810. https://doi.org/10.1155/2018/3237810
  • 28. Rosenberg AA, Kinsella JP. Effect of extracorporeal membrane oxygenation on cerebral hemodynamics in newborn lambs. Crit Care Med 1992; 20: 1568- 1581. https://doi.org/10.1097/00003246-199211000- 00016
  • 29. Short BL, Walker LK, Bender KS, Traystman RJ. Impairment of cerebral autoregulation during extracorporeal membrane oxygenation in newborn lambs. Pediatr Res 1993; 33: 289-294. https://doi. org/10.1203/00006450-199303000-00018
  • 30. Papademetriou MD, Tachtsidis I, Elliot MJ, Hoskote A, Elwell CE. Multichannel near infrared spectroscopy indicates regional variations in cerebral autoregulation in infants supported on extracorporeal membrane oxygenation. J Biomed Opt 2012; 17: 067008. https://doi.org/10.1117/1. JBO.17.6.067008
  • 31. Ingyinn M, Rais-Bahrami K, Viswanathan M, Short BL. Altered cerebrovascular responses after exposure to venoarterial extracorporeal membrane oxygenation: role of the nitric oxide pathway. Pediatr Crit Care Med 2006; 7: 368-373. https://doi. org/10.1097/01.PCC.0000225372.38460.12
  • 32. Caicedo A, De Smet D, Naulaers G, et al. Cerebral tissue oxygenation and regional oxygen saturation can be used to study cerebral autoregulation in prematurely born infants. Pediatr Res 2011; 69: 548- 553. https://doi.org/10.1203/PDR.0b013e3182176d85
  • 33. Lorusso R, Vizzardi E, Pinelli L, Gelsomino S. Posterior reversible encephalopathy syndrome in a patient submitted to extracorporeal membrane oxygenation for acute fulminant myocarditis. Int J Cardiol 2014; 172: e329-30. https://doi.org/10.1016/j. ijcard.2013.12.275
  • 34. Dominedò C, D’Avino E, Martinotti A, Cingolani E. A rare pheochromocytoma complicated by cardiogenic shock and posterior reversible encephalopathy syndrome: case report. Eur Heart J Case Rep 2021; 5: ytaa513. https://doi.org/10.1093/ ehjcr/ytaa513
  • 35. Menaker J, Tabatabai A, Rector R, et al. Incidence of cannula-associated deep vein thrombosis after venovenous extracorporeal membrane oxygenation. ASAIO J 2017; 63: 588-591. https://doi.org/10.1097/ MAT.0000000000000539
APA GÜMELER E, Katlan B, parlak s, Kesici S, BAYRAKCI B, KARLI OGUZ H (2022). Imaging spectrum of extracorporeal membrane oxygenation related neurologic events in children. , 882 - 891. 10.24953/turkjped.2022.323
Chicago GÜMELER Ekim,Katlan Banu,parlak safak,Kesici Selman,BAYRAKCI BENAN,KARLI OGUZ H.KADER Imaging spectrum of extracorporeal membrane oxygenation related neurologic events in children. (2022): 882 - 891. 10.24953/turkjped.2022.323
MLA GÜMELER Ekim,Katlan Banu,parlak safak,Kesici Selman,BAYRAKCI BENAN,KARLI OGUZ H.KADER Imaging spectrum of extracorporeal membrane oxygenation related neurologic events in children. , 2022, ss.882 - 891. 10.24953/turkjped.2022.323
AMA GÜMELER E,Katlan B,parlak s,Kesici S,BAYRAKCI B,KARLI OGUZ H Imaging spectrum of extracorporeal membrane oxygenation related neurologic events in children. . 2022; 882 - 891. 10.24953/turkjped.2022.323
Vancouver GÜMELER E,Katlan B,parlak s,Kesici S,BAYRAKCI B,KARLI OGUZ H Imaging spectrum of extracorporeal membrane oxygenation related neurologic events in children. . 2022; 882 - 891. 10.24953/turkjped.2022.323
IEEE GÜMELER E,Katlan B,parlak s,Kesici S,BAYRAKCI B,KARLI OGUZ H "Imaging spectrum of extracorporeal membrane oxygenation related neurologic events in children." , ss.882 - 891, 2022. 10.24953/turkjped.2022.323
ISNAD GÜMELER, Ekim vd. "Imaging spectrum of extracorporeal membrane oxygenation related neurologic events in children". (2022), 882-891. https://doi.org/10.24953/turkjped.2022.323
APA GÜMELER E, Katlan B, parlak s, Kesici S, BAYRAKCI B, KARLI OGUZ H (2022). Imaging spectrum of extracorporeal membrane oxygenation related neurologic events in children. Turkish Journal of Pediatrics, 64(5), 882 - 891. 10.24953/turkjped.2022.323
Chicago GÜMELER Ekim,Katlan Banu,parlak safak,Kesici Selman,BAYRAKCI BENAN,KARLI OGUZ H.KADER Imaging spectrum of extracorporeal membrane oxygenation related neurologic events in children. Turkish Journal of Pediatrics 64, no.5 (2022): 882 - 891. 10.24953/turkjped.2022.323
MLA GÜMELER Ekim,Katlan Banu,parlak safak,Kesici Selman,BAYRAKCI BENAN,KARLI OGUZ H.KADER Imaging spectrum of extracorporeal membrane oxygenation related neurologic events in children. Turkish Journal of Pediatrics, vol.64, no.5, 2022, ss.882 - 891. 10.24953/turkjped.2022.323
AMA GÜMELER E,Katlan B,parlak s,Kesici S,BAYRAKCI B,KARLI OGUZ H Imaging spectrum of extracorporeal membrane oxygenation related neurologic events in children. Turkish Journal of Pediatrics. 2022; 64(5): 882 - 891. 10.24953/turkjped.2022.323
Vancouver GÜMELER E,Katlan B,parlak s,Kesici S,BAYRAKCI B,KARLI OGUZ H Imaging spectrum of extracorporeal membrane oxygenation related neurologic events in children. Turkish Journal of Pediatrics. 2022; 64(5): 882 - 891. 10.24953/turkjped.2022.323
IEEE GÜMELER E,Katlan B,parlak s,Kesici S,BAYRAKCI B,KARLI OGUZ H "Imaging spectrum of extracorporeal membrane oxygenation related neurologic events in children." Turkish Journal of Pediatrics, 64, ss.882 - 891, 2022. 10.24953/turkjped.2022.323
ISNAD GÜMELER, Ekim vd. "Imaging spectrum of extracorporeal membrane oxygenation related neurologic events in children". Turkish Journal of Pediatrics 64/5 (2022), 882-891. https://doi.org/10.24953/turkjped.2022.323