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

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

Published Open-Access

yes

Keywords

anticoagulation, child, extracorporeal membrane oxygenation, hemorrhage, mortality

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.