Short-Term Neurologic Outcomes in Pediatric Extracorporeal Membrane Oxygenation Are Proportional to Bleeding Severity Graded by a Novel Bleeding Scale

Authors

Katherine Doane
Danielle Guffey
Laura L Loftis
Trung C Nguyen
Matthew A Musick
Amanda Ruth
Ryan D Coleman
Jun Teruya
Christine Allen
Melania M Bembea
Brian Boville
Jamie Furlong-Dillard
Santosh Kaipa
Mara Leimanis
Matthew P Malone
Lindsey K Rasmussen
Ahmed Said
Marie E Steiner
Deanna T Tzanetos
Heather Viamonte
Linda Wallenkamp
Arun Saini

Language

English

Publication Date

10-18-2024

Journal

Perfusion

DOI

10.1177/02676591241293673

PMID

39425501

PubMedCentral® Posted Date

10-18-2024

PubMedCentral® Full Text Version

Post-print

Abstract

Introduction: This study aimed to characterize the severity of bleeding and its association with short-term neurologic outcomes in pediatric ECMO.

Methods: Multicenter retrospective cohort study of pediatric ECMO patients at 10 centers utilizing the Pediatric ECMO Outcomes Registry (PEDECOR) database from December 2013-February 2019. Subjects excluded were post-cardiac surgery patients and those with neonatal pathologies. A novel ECMO bleeding scale was utilized to categorize daily bleeding events. Poor short-term neurologic outcome was defined as an unfavorable Pediatric Cerebral Performance Category (PCPC) or Pediatric Overall Performance Category (POPC) (score of >3) at hospital discharge.

Results: This study included 283 pediatric ECMO patients with a median (interquartile range [IQR]) age of 1.3 years [0.1, 9.0], ECMO duration of 5 days [3.0, 9.5], and 44.1% mortality. Unfavorable PCPC and POPC were observed in 48.4% and 51.3% of patients at discharge, respectively. Multivariable logistic regression analysis included patient's age, cannulation type, duration of ECMO, need for cardiopulmonary resuscitation, acute kidney injury, new infection, and vasoactive-inotropic score. As the severity of bleeding increased, there was a corresponding increase in the likelihood of poor neurologic recovery, shown by increasing odds of unfavorable neurologic outcome (PCPC), with an adjusted odds ratio (aOR) of 0.77 (confidence interval [CI] 0.36-1.62), 1.87 (0.54-6.45), 2.97 (1.32-6.69), and 5.56 (0.59-52.25) for increasing bleeding severity (grade 1 to 4 events, respectively). Similarly, unfavorable POPC aOR (CI) was 1.02 (0.48-2.17), 2.05 (0.63-6.70), 5.29 (2.12-13.23), and 5.11 (0.66-39.64) for bleeding grade 1 to 4 events.

Conclusion: Short-term neurologic outcomes in pediatric ECMO are proportional to the severity of bleeding events. Strategies to mitigate bleeding events could improve neurologic recovery in pediatric ECMO.

Keywords

anticoagulation, child, extracorporeal membrane oxygenation, hemorrhage, mortality

Published Open-Access

yes

Recommended Citation

Doane, Katherine; Guffey, Danielle; Loftis, Laura L; et al., "Short-Term Neurologic Outcomes in Pediatric Extracorporeal Membrane Oxygenation Are Proportional to Bleeding Severity Graded by a Novel Bleeding Scale" (2024). Center for Medical Ethics and Health Policy Staff Publications. 56.
https://digitalcommons.library.tmc.edu/med_ethics/56