Intensive Care Medicine

, Volume 39, Issue 9, pp 1594–1601

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

  • Angelo Polito
  • Cindy S. Barrett
  • David Wypij
  • Peter T. Rycus
  • Roberta Netto
  • Paola E. Cogo
  • Ravi R. Thiagarajan
Original

Abstract

Background

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.

Patients and methods

Retrospective cohort study of neonates (age ≤30 days) supported with ECMO using data reported to the Extracorporeal Life Support Organization during 2005–2010.

Results

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).

Conclusions

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.

Keywords

Extracorporeal membrane oxygenation Neonate Brain injury Neurologic complications 

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2013

Authors and Affiliations

  • Angelo Polito
    • 1
  • Cindy S. Barrett
    • 2
  • David Wypij
    • 3
    • 5
  • Peter T. Rycus
    • 4
  • Roberta Netto
    • 1
  • Paola E. Cogo
    • 1
  • Ravi R. Thiagarajan
    • 5
  1. 1.Attending Physician, Department of Cardiology and Cardiac Surgery, Cardiac Intensive Care UnitBambino Gesù Pediatric Hospital, IRCCSRomeItaly
  2. 2.Cardiac Intensive Care UnitDenver Children’s HospitalDenverUSA
  3. 3.Department of BiostatisticsHarvard School of Public HealthBostonUSA
  4. 4.Extracorporeal Life Support Organization (ELSO)University of MichiganAnn ArborUSA
  5. 5.Cardiac Intensive Care UnitBoston Children’s HospitalBostonUSA

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