Short-term neurologic outcomes in pediatric extracorporeal membrane oxygenation are proportional to bleeding severity graded by a novel bleeding scale

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 ViamonteLinda Wallenkamp, Arun Saini

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
JournalPerfusion
DOIs
StateAccepted/In press - 2024

Keywords

  • anticoagulation
  • child
  • extracorporeal membrane oxygenation
  • hemorrhage
  • mortality
  • outcome

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