Table 2.
Patient | Primary Diagnosis | ECMO Indication |
ECMO Duration |
#GFAP Measure ments |
Peak GFAP |
ANI Diagnosed during ECMO | ANI Diagnostic Modality |
ECMO to ANI Diagnosis |
ECMO to GFAP >95th percentile |
Baseline PCPC |
Discharge PCPC |
Neurologic Outcome |
PICU Survival |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | Liver failure, CPA post-transplant |
Cardiac disease |
4d | 5 | 5.86 | Unilateral IVH, intraparenchymal (basal ganglia, right temporal and occipital) hemorrhage,2 cm midline shift, edema |
HCT | 104h | 24h | 1 | 6 | Poor | No |
2 | Dilated cardiomyopathy |
Cardiac disease |
3d | 4 | 20.5 | Frontoparietal 4×5×4cm intra- parenchymal hemorrhage, 2.5cm mildline shift, unilateral SDH, SAH, IVH |
HUS | 11h | 19h | 2 | 6 | Poor | No |
3 | Dilated cardiomyopathy |
Cardiac disease |
5d | 3 | 0.053 | No | - | - | - | 1 | 1 | Good | Yes |
4 | PPHN | Respiratory disease |
6d | 4 | 0.164 | No | - | - | - | 1 | 2 | Good | Yes |
5 | Septic shock | Sepsis | 1d | 1 | 0a | No | - | - | - | 1 | 6 | Poor | No |
6 | PPHN | Respiratory disease |
5d | 8 | 0.088 | No | - | - | - | 2 | 2 | Good | Yes |
7 | PPHN | Respiratory disease |
4d | 5 | 0.081 | No | - | - | - | 1 | 1 | Good | Yes |
8 | Dilated Cardiomyopathy |
Cardiac disease |
1d | 2 | 0.162 | No | - | - | - | 1 | 1 | Good | Yes |
9 | PPHN | Respiratory disease |
7d | 7 | 0.062 | No | - | - | - | 1 | 2 | Good | Yes |
10 | Critical aortic stenosis |
Cardiac disease |
12d | 6 | 0.194 | No | - | - | - | 1 | 1 | Good | Yes |
11 | PPHN | Respiratory disease |
30d | 16 | 1.43 | No | - | - | 12hb | 1 | 3 | Poor | Yes |
12 | Diaphragmatic eventration |
Respiratory disease |
14d | 11 | 0.398 | Unilateral cerebellar hemisphere, 1.5× 2cm intraparenchymal hemorrhage |
HUS | 82h | - | 1 | 6 | Poor | No |
13 | TOF, Pulmonary atresia |
ECPR | 4d | 3 | 0.090 | No | - | - | - | 1 | 2 | Good | Yes |
14 | Status asthmaticus | ECPR | 4d | 2 | 44.9 | Rapid progression to brain death | BD exam | 64h | 12h | 1 | 6 | Poor | No |
15 | PPHN | Respiratory disease |
12d | 3 | 0.795 | No | - | - | 10dc | 1 | 2 | Good | Yes |
16 | PPHN | Respiratory disease |
15d | 11 | 0.111 | Small SDH along the falx cerebri | HUS | 10d | - | 1 | 1 | Good | Yes |
17 | PPHN | Respiratory disease |
4d | 3 | 0.155 | No | - | - | - | 1 | 1 | Good | Yes |
18 | CDH | Respiratory disease |
18d | 13 | 0.400 | No | - | - | - | 1 | 6 | Poor | No |
19 | Truncus arteriosus | Cardiac disease |
4d | 2 | 0a | No | - | - | - | 1 | 1 | Good | Yes |
20 | PPHN | Respiratory disease |
3d | 1 | 0a | Unilateral subependymal grade I IVH | HUS | 69h | - | 1 | 1 | Good | Yes |
21 | CDH | Respiratory disease |
17d | 8 | 0a | No | - | - | - | 1 | 1 | Good | Yes |
22 | Neonatal enterovirus sepsis |
ECPR | 8d | 8 | 14.6 | Severe diffuse cerebral edema | HUS | 2h | 6h | 3 | 6 | Poor | No |
ECMO: extracorporeal membrane oxygenation, ANI: acute neurologic injury, GFAP: glial fibrillary acidic protein, PCPC: Pediatric Cerebral Performance Category, PICU: pediatric intensive care unit, CPA: cardiopulmonary arrest, IVH: intraventricular hemorrhage, SDH: subdural hemorrhage, SAH: subarachnoid hemorrhage, HCT: head computed tomography, HUS: head ultrasound, PPHN: persistent pulmonary hypertension of the newborn, TOF: tetralogy of Fallot, ECPR: extracorporeal cardiopulmonary resuscitation, CDH: congenital diaphragmatic hernia.
Denotes values below the lower limit of quantification (LLQ=0.040 ng/mL)
Normal serial HUS during ECMO. Brain MRI 6 weeks post-ECMO decannulation: few old intraventricular and intraparenchymal hemorrhagic foci
Normal serial HUS during ECMO. Brain MRI 2 weeks post-ECMO decannulation: unilateral unilobar focal encephalomalacia consistent with prior ischemic event