title: Neurological complications of extracorporeal membrane oxygenation in children.
abstract: OBJECTIVE
  Extracorporeal membrane oxygenation (ECMO) is a potentially life-saving treatment for patients in refractory cardiorespiratory failure. Neurological complications that result from ECMO treatment are known to significantly impact patient survival and quality of life. The purpose of this study was to review the incidence of neurological complications of ECMO in the pediatric population and the role of neurosurgery in the treatment of these patients.
  
  
  METHODS
  Data were obtained from the national Extracorporeal Life Support Organization (ELSO) Registry for the years 1990 to 2009. The neurological complications recorded by the registry include CNS hemorrhage, CNS infarction, and seizure. The ECMO Registry at the authors' institution was then searched, and 3 pediatric patients who had undergone craniotomy during ECMO treatment were identified.
  
  
  RESULTS
  Children in the ELSO Registry who were treated with ECMO survived to hospital discharge in 65% of cases. Intracranial hemorrhage occurred in 7.4% of the ECMO-treated patients, with 36% of those surviving to hospital discharge. Hemorrhage was more likely in patients younger than 30 days old and in those requiring ECMO for cardiac indications. Cerebral infarction occurred in 5.7% of all ECMO-treated patients. Clinically diagnosed seizures occurred in 8.4% of all ECMO-treated patients. The ECMO Registry at the authors' institution revealed that 1898 patients were treated there. Intracranial hemorrhage was diagnosed in 81 patients (5.8%), and 3 of these patients were treated with craniotomy. Two of the patients were alive with minimal neurological impairment and normal school performance at 10 and 16 years of follow-up.
  
  
  CONCLUSIONS
  Intracranial hemorrhage is a serious complication of ECMO treatment. While the surgical risk is substantial, there may be a role for surgical evacuation of hemorrhage in well-selected patients.
authors: Department of Neurosurgery, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, Michigan 48109-5338, USA.
authors: Shawn L
authors: SL
authors: Hervey-Jumper
authors: Gail M
authors: GM
authors: Annich
authors: Andrea R
authors: AR
authors: Yancon
authors: Hugh J L
authors: HJ
authors: Garton
authors: Karin M
authors: KM
authors: Muraszko
authors: Cormac O
authors: CO
authors: Maher
mesh_terms: D000257:Adenoviridae Infections / Q000150:complications; D000293:Adolescent; D000367:Age Factors; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D002543:Cerebral Hemorrhage / Q000601:surgery; D002544:Cerebral Infarction / Q000453:epidemiology / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D003399:Craniotomy; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D005260:Female; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009422:Nervous System Diseases / Q000453:epidemiology / Q000209:etiology*; D011446:Prospective Studies; D012042:Registries; D012128:Respiratory Distress Syndrome / Q000628:therapy; D012131:Respiratory Insufficiency / Q000628:therapy; D018357:Respiratory Syncytial Virus Infections / Q000150:complications; D012640:Seizures / Q000209:etiology; D013226:Status Epilepticus / Q000150:complications; D014057:Tomography, X-Ray Computed; D014481:United States / Q000453:epidemiology
chemical_list: D000925:Anticoagulants; D006493:Heparin