(783) Epidemiology of Intracranial Hemorrhage in Children Supported by Extracorporeal Membrane Oxygenation

Introduction: Children supported by extracorporeal membrane oxygenation (ECMO) are at significant risk for intracranial hemorrhage (ICH). Associated risk factors and temporal patterns of bleeding events are not clearly defined. We sought to describe the use of head imaging and the prevalence of ICH in children supported by ECMO.

Methods: A retrospective analysis of the Pediatric ECMO Outcomes Registry (PEDECOR) was performed. Patients 0 to 24 months of age supported by ECMO at twelve centers in the United States from 1/1/2014 to 6/30/2022 were identified. Patients with prior ECMO support, ICH prior to the start of ECMO, and those children with no head imaging during or after ECMO support were excluded.

Results: Of 1094 children ages 0-24 months supported by ECMO during the study period, 460 (42%) had at least one head image performed (total of 524 images). Fifty-one percent (235/460) of the patients were male, and the median (IQR) age was 0.8 (0.1-4.0) months. Seventy-six percent (348/460) of ECMO support was veno-arterial. The majority of images were ultrasounds (434, 94%) followed by CTs (87, 19%) and MRIs (3, < 1%). 111 children (29%) were found to have ICH. Eighty-four percent (93/111) of ICH were identified within the first five days of ECMO. Children with ICH were younger, median (IQR) age 0.4 (0-2.4) months, as compared to those without ICH, 1.3 (0.2-4.5) months, p< 0.001. There were differences in platelet count between the two groups; the median (IQR) platelet count prior to the bleeding event was 86 (62-108) x109/L for children with ICH as compared to 56 (36-77) x109/L for children without ICH, p< 0.001. Children with ICH were more likely to die during their ICU admission (ICU mortality 64% as compared to 43% in children without ICH, p< 0.001). Of those who survived, children diagnosed with ICH were more likely to have a new neurologic disorder (74% as compared to 25% in children without ICH, p < 0.001).

Conclusions: ICH in children receiving ECMO is common, occurs early in the ECMO course, is associated with younger age, but not the degree of thrombocytopenia. Given the associated morbidity and mortality of ICH, this patient population may benefit from evidence-based protocol development to decrease variability in obtaining head imaging.