title: Epidemiology of Stroke in Pediatric Cardiac Surgical Patients Supported With Extracorporeal Membrane Oxygenation.
abstract: BACKGROUND
  Stroke is a common complication of extracorporeal membrane oxygenation (ECMO), and pediatric cardiac surgical patients may be at higher risk. Epidemiology and risk factors for stroke in these patients are not well characterized.
  
  
  METHODS
  We analyzed pediatric (<18 years) cardiac ECMO cases in the Extracorporeal Life Support Organization Registry from 2002 to 2013. Cardiac surgical patients were identified, and procedures were stratified according to The Society of Thoracic Surgeons morbidity categories. The primary outcome was any stroke (hemorrhagic or infarction) identified by neuroimaging. Risk factors were identified through multivariable logistic regression.
  
  
  RESULTS
  We analyzed 3,517 cardiac surgical patients; 81% with cyanotic disease, and 57% in high-risk categories from The Society of Thoracic Surgeons (categories 4 and 5). Overall, 12% experienced stroke while receiving ECMO, and those with stroke had greater in-hospital mortality (72% versus 51%; p < 0.0001). In multivariable analysis, neonatal status (adjusted odds ratio, 1.8; 95% confidence interval, 1.3 to 2.4), lower weight-for-age z score (adjusted odds ratio, 1.1 for each 1-point decrease; 95% confidence interval, 1.04 to 1.25), and longer ECMO duration (upper quartile [≥ 167 hours] adjusted odds ratio, 1.4; 95% confidence interval, 1.1 to 1.8) were independently associated with increased stroke risk, whereas cyanotic disease, The Society of Thoracic Surgeons category, and bypass time were not.
  
  
  CONCLUSIONS
  This multicenter analysis demonstrates that pediatric cardiac surgical patients on ECMO are at high risk of stroke; younger or underweight patients and those with longer ECMO duration are at greatest risk, independent of procedural complexity. Future study is necessary to determine how anticoagulation or other clinical practices can be modified to reduce stroke incidence.
authors: University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, Michigan. Electronic address: dwerho@med.umich.edu.
authors: David K
authors: DK
authors: Werho
authors: University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, Michigan.
authors: Sara K
authors: SK
authors: Pasquali
authors: University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, Michigan.
authors: Sunkyung
authors: S
authors: Yu
authors: University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, Michigan.
authors: Janet
authors: J
authors: Donohue
authors: Department of Critical Care Medicine, Toronto Hospital for Sick Children, Toronto, Ontario, Canada.
authors: Gail M
authors: GM
authors: Annich
authors: Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.
authors: Ravi R
authors: RR
authors: Thiagarajan
authors: University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, Michigan.
authors: Jennifer C
authors: JC
authors: Hirsch-Romano
authors: University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, Michigan.
authors: Michael
authors: M
authors: Gaies
mesh_terms: D000293:Adolescent; D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology*; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology*; D013997:Time Factors