Original articleCongenital heart surgeryEpidemiology of Stroke in Pediatric Cardiac Surgical Patients Supported With Extracorporeal Membrane Oxygenation
Section snippets
Data Source
The Extracorporeal Life Support Organization (ELSO) maintains a registry of ECMO data from more than 350 international ECMO centers and currently houses information from greater than 58,000 ECMO runs since 1990. Each participating ECMO center collects and voluntarily reports standardized data on all patients undergoing ECMO including patient characteristics, details of the ECMO run, complications, and outcomes. Centers submit a cardiac addendum for patients who required ECMO for cardiac support
Demographics
Our inclusion criteria identified 3,517 cardiac surgical patients requiring ECMO postoperatively. Characteristics of the cohort are presented in Table 1; 54% were neonates (age <30 days), 96% had structural heart disease (81% cyanotic), and 57% were in STS categories 4 or 5. Extracorporeal membrane oxygenation duration varied considerably (median, 104 hours; interquartile range, 64 to 167).
Stroke and Outcomes
Surgical patients had a 12.3% incidence of stroke with high rates of hemorrhagic stroke (10%), and low
Comment
This is the first multicenter analysis of stroke epidemiology in pediatric cardiac surgical patients on ECMO. We showed the incidence of hemorrhagic stroke is higher and the incidence of ischemic stroke is lower in cardiac surgical patients compared with previously published rates in mixed cohorts of children on ECMO [4], and that the risk of death is greatly increased in patients with stroke. Neonatal age, lower weight-for-age z score, and longer ECMO duration were independently associated
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2022, Seminars in Fetal and Neonatal MedicineCitation Excerpt :The ELSO Registry reported an incidence of 24% of any type of neurological event in neonates on cardiac ECMO support [1]. Neonates supported on ECMO post cardiac surgery had an adjusted odds ratio (OR) of 1.8 for developing stroke (hemorrhage or infarction) [33]. In neonates on ECMO for respiratory failure, cardiac failure and following ECPR, the ELSO Registry (2017–2021) reported intracranial hemorrhage in 4.9%, 4.7%, and 5.8%, respectively [1].
Pediatric Stroke and Cardiac Disease: Challenges in Recognition and Management
2022, Seminars in Pediatric NeurologyCitation Excerpt :Additional risk factors can be grouped into three main categories: (1) Alterations in blood composition (eg, acquired prothrombotic states due to sepsis or surgery), (2) alterations in blood flow promoting thrombus formation (implanted valves),9 and anatomical flow obstructions or impaired function additionally contributing to impaired cerebral perfusion, and (3) alterations in the endothelium (implanted or intravascular prosthetic materials). Cardiac surgery, catheterization,10 and mechanical circulatory support (MCS) including ventricular assist devices (VAD)11 or extracorporeal membrane oxygenation (ECMO),12 combine multiple risk factors and are associated with high rates of neurologic injury. Common patterns of cardioembolic stroke include large vessel occlusion (LVO) and/or multifocal, often bilateral, showers of microemboli affecting multiple vascular territories (Fig 1).
Common carotid artery imaging after vessel sparing decannulation from Extracorporeal Membrane Oxygenation (ECMO) support
2021, Journal of Pediatric SurgeryRisk Factors for Hemolysis During Extracorporeal Life Support for Congenital Diaphragmatic Hernia
2021, Journal of Surgical ResearchCitation Excerpt :CDH infants treated with ECLS are less likely to survive and require prolonged support compared with other neonatal conditions.1,2 In turn, longer periods of ECLS support are associated with higher rates of on-ECLS complications (e.g., sepsis, bleeding, and stroke).3-5 One such complication is hemolysis, which is typically defined as a plasma-free hemoglobin (PFH) >50 mg/dL.