Presenter of 2 Presentations
ELECTROENCEPHALOGRAPHIC PREDICTION OF STROKE IN CHILDREN REQUIRING EXTRACORPOREAL MEMBRANE OXYGENATION
ELECTROENCEPHALOGRAPHIC PREDICTION OF STROKE IN CHILDREN REQUIRING EXTRACORPOREAL MEMBRANE OXYGENATION
Abstract
Background and Aims
Extracorporeal Membrane Oxygenation (ECMO) is highly associated with arterial ischemic and hemorrhagic stroke, yet there is paucity of biomarkers available to predict such injuries in children. This study aimed at identifying electroencephalographic predictors of stroke in children requiring ECMO.
Methods
We prospectively enrolled children with continuous electroencephalographic recordings requiring ECMO support. We measured maximal hourly seizure burden, interictal epileptiform discharges, and quantitative electroencephalographic features (power in alpha, beta, theta and delta bands, alpha-delta ratio, total power, amplitude, differences between cerebral hemispheres and suppression ratio) obtained during the final 24 hours of recording while on ECMO support. The primary outcomes were the occurrence of ischemic or hemorrhagic stroke. Univariate logistic regression was used to identify predictors of ischemic or hemorrhagic stroke.
Results
Seventy-one children (female, 48%) with a median age of 1.1 [IQR: 0.02 – 10.2] years were enrolled. Of these, 10 patients suffered stroke, including 7 with arterial ischemic stroke and 3 with hemorrhagic stroke. The presence of interictal epileptiform discharges (OR: 26.667, 95% CI [4.251 – 207.707], p<0.001) was predictive of arterial ischemic stroke, whereas differences in alpha (8-13 Hz) power (OR: 110.230, 95% CI [1.414 – 1.645], p= 0.04), total (1-20 Hz) power (OR: 2.872, 95% CI [1.546 – 7.817], p= 0.005) and amplitude (OR: 9.231, 95% CI [2.289 – 202.413], p= 0.03) across each cerebral hemisphere were predictive of hemorrhagic stroke.
Conclusions
The presence of interictal epileptiform discharges was associated with arterial ischemic stroke whereas asymmetry in alpha power, total power and amplitude across each cerebral hemisphere predicted hemorrhagic stroke.