Abstracts

Rationale: Extracorporeal membrane oxygenation (ECMO) is an important life-saving technology for pediatric patients with respiratory or cardiac failure; however, it involves significant risk of neurologic sequelae, including stroke and seizures. These patients frequently receive neuromuscular blockade, precluding clinical examination. Continuous EEG monitoring therefore represents a practical method of surveillance for central nervous system (CNS) injury and can help direct management. Methods: Twenty-eight children aged 0 days to 17 years consecutively receiving ECMO at our institution for cardiac or respiratory failure between March 2010 and June 2012 were placed on continuous EEG monitoring as part of a standard neuromonitoring protocol. All recordings utilized plastic electrodes to minimize the possibility of artifact as usually seen using standard electrodes. Results: All 28 patients had abnormal findings on EEG. 18% (5 out of 28) had seizures, all of which had cardiac disease. 80% (4 out of 5) had subclinical seizures, with one patient found to be in nonconvulsive status epilepticus. EEG findings changed management by initiation of antiepileptics (5 patients), urgent neuroimaging (8 patients), or withdrawal of care (6 patients). In the 22 patients with cardiac disease, the median age of those with seizures was 17 days, and the oldest patient with seizures was 173 days old. Conclusions: Children undergoing ECMO therapy are at risk for seizures, especially those with cardiac disease and of younger age. Continuous video EEG monitoring can significantly impact management in patients on ECMO, especially when neuroimaging and clinical exam cannot be obtained due to the patient's tenuous clinical status and neuromuscular blockade. Supported in part by the Julie & Steve DesJardins Fellowship, CARE AND CURE, Epilepsy Foundation of Greater Los Angeles.