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Meta-Analysis
. 2023 Mar;93(4):755-762.
doi: 10.1038/s41390-022-02187-5. Epub 2022 Jul 29.

Seizures in children undergoing extracorporeal membrane oxygenation: a systematic review and meta-analysis

Guisen Lin #  1 , Yaowen Li #  1 , Yijiang Zhuang  1 , Qimeng Fan  2 , Yi Luo  1   3 , Hongwu Zeng  4
Affiliations
Meta-Analysis

Seizures in children undergoing extracorporeal membrane oxygenation: a systematic review and meta-analysis

Guisen Lin et al. Pediatr Res. 2023 Mar.

Abstract

Objectives: To investigate the incidence of seizures and short-term mortality associated with seizures in children undergoing extracorporeal membrane oxygenation (ECMO).

Methods: PubMed, Embase, and Web of Science were searched from inception to September 2021. Study quality was assessed using the Newcastle-Ottawa Scale. Random effects meta-analysis was conducted.

Results: Fourteen studies met the inclusion criteria for quantitative meta-analysis. The cumulative estimate of seizure incidence was 15% (95% CI: 12-17%). Studies using electroencephalography reported a higher incidence of seizures compared with those using electro-clinical criteria (19% vs. 9%, P = 0.034). Furthermore, 75% of seizures were subclinical. Children receiving extracorporeal cardiopulmonary resuscitation (ECPR) exhibited a higher incidence of seizures compared to children with respiratory and cardiac indications. Seizure incidence was higher in patients undergoing venoarterial (VA) ECMO compared with venovenous (VV) ECMO. The pooled odds ratio of mortality was 2.58 (95% CI: 2.25-2.95) in those developed seizures.

Conclusion: The incidence of seizures in children requiring ECMO was 15% and majority of seizures were subclinical. The incidence of seizures was higher in patients receiving ECPR than in those with respiratory and cardiac indications. Seizures were more frequent in patients undergoing VA ECMO than VV ECMO. Seizures were associated with increased short-term mortality.

Impact: The incidence of seizures in children undergoing extracorporeal membrane oxygenation (ECMO) was ~15% and majority of the seizures were subclinical. Seizures were associated with increased short-term mortality. Risk factors for seizures were extracorporeal cardiopulmonary resuscitation and venoarterial ECMO. Electroencephalography (EEG) monitoring is recommended in children undergoing ECMO and further studies on the optimal protocol for EEG monitoring are necessary.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. The selection process was performed following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) principles.
Preferred reporting items for systematic review and meta-analysis (PRISMA) flow diagram for articles identification and inclusion.
Fig. 2
Fig. 2. Forest plot of the prevalence of seizures among children undergoing extracorporeal membrane oxygenation.
The incidence of seizures was calculated using a random-effects model. *Only pediatric patients were included for analysis for the study “Hervery-Jumper 2011” since the neonatal patients largely overlapped with study “Zwischenberger 1993” and “Polito 2013”. CI confidence interval, ES estimate.
Fig. 3
Fig. 3. Meta-analysis of specific subgroups.
A Forest plot of the incidence of seizures in studies that applied EEG for seizure diagnosis versus studies using electro-clinical criteria. B Forest plot of the proportion of subclinical non-convulsive seizure. C Forest plot of the incidence of seizures in patients with cardiac, respiratory, and ECPR indications, respectively. D Forest plot of the incidence of seizures in patients with venoarterial ECMO versus patients with venovenous ECMO. The incidence of seizures and proportion of subclinical seizures were calculated using a random-effects model. CI confidence interval, ECPR extracorporeal cardiopulmonary resuscitation, ECMO extracorporeal membrane oxygenation, EEG electroencephalography, ES estimate.
Fig. 4
Fig. 4. Forest plot of the pooled OR of short-term mortality among children undergoing extracorporeal membrane oxygenation who developed seizures.
The OR of short-term mortality was calculated using a random-effects model. CI confidence interval, OR odds ratio.
See this image and copyright information in PMC

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References

    1. White JJ, Andrews HG, Risemberg H, Mazur D, Haller JA., Jr Prolonged respiratory support in newborn infants with a membrane oxygenator. Surgery. 1971;70:288–296. - PubMed
    1. Hill JD, et al. Prolonged extracorporeal oxygenation for acute post-traumatic respiratory failure (shock-lung syndrome). use of the bramson membrane lung. N. Engl. J. Med. 1972;286:629–634. doi: 10.1056/NEJM197203232861204. - DOI - PubMed
    1. Thiagarajan RR, et al. Extracorporeal life support organization registry international report 2016. ASAIO J. 2017;63:60–67. doi: 10.1097/MAT.0000000000000475. - DOI - PubMed
    1. Barbaro RP, et al. Extracorporeal membrane oxygenation for Covid-19: evolving outcomes from the international extracorporeal life support organization registry. Lancet. 2021;398:1230–1238. doi: 10.1016/S0140-6736(21)01960-7. - DOI - PMC - PubMed
    1. Abend NS, Dlugos DJ, Clancy RR. A review of long-term eeg monitoring in critically ill children with hypoxic-ischemic encephalopathy, congenital heart disease, ecmo, and stroke. J. Clin. Neurophysiol. 2013;30:134–142. doi: 10.1097/WNP.0b013e3182872af9. - DOI - PMC - PubMed

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