(275) Outcomes of Pediatric Cardiac ICU Patients With Intracranial Hemorrhage on ECMO

Introduction: Intracranial hemorrhage (ICH) is a serious complication of extracorporeal membrane oxygenation (ECMO) that can impact outcomes and duration of time clinicians continue ECMO support. We hypothesized that in pediatric cardiac ICU patients, receipt of cardiopulmonary resuscitation (CPR) peri-cannulation is associated with earlier diagnosis of ICH and that clinicians would discontinue ECMO support within 48 hours of ICH diagnosis in the majority of patients with ICH while on ECMO.

Methods: Retrospective, single-center study of pediatric CICU patients < 18 years who were diagnosed with ICH by head ultrasound or CT on ECMO or within 1 week of decannulation from January 2014 to January 2022. Data are summarized as proportions for categorical and medians with interquartile ranges (IQR) for continuous variables. Wilcoxon rank sum test was used to compare continuous variables across groups.

Results: Of 325 pediatric CICU patients on ECMO, 28 (8.6%) were diagnosed with ICH: 89% (25/28) while on ECMO and 11% (3/28) within 1 week of decannulation. 39% (11/28) of patients received CPR peri-cannulation. Median age of patients with ICH was 3.5 weeks (IQR 1, 46); 96% (27/28) were supported with VA-ECMO. ICH was diagnosed < 12 hours after cannulation in 46% (13/28). Median time to ICH diagnosis after cannulation was 17 hours (IQR 6, 146) and was not statistically different in those who received CPR peri-cannulation compared to those who did not [median 8 (IQR 6, 98) vs. 51 (IQR 6, 200) hours, p=0.3]. Extra-axial hemorrhage was the most common ICH seen in 39% (11/28), followed by intraventricular (32%), parenchymal (14%), and multi-compartmental (14%). Of patients who had ICH diagnosed while on ECMO, median time to decannulation was 67 hours (IQR 21, 148) and 36% (9/25) were decannulated within 48 hours. No patients underwent neurosurgical intervention for ICH. Hospital mortality was 54% (15/28) after diagnosis of ICH.

Conclusions: Contrary to our hypotheses, among those diagnosed with ICH, CPR peri-cannulation was not associated with earlier diagnosis of ICH and the majority of patients diagnosed with an ICH on ECMO were decannulated more than 48 hours after ICH was identified. Future research is needed to identify effective ECMO management strategies that improve hospital mortality after identification of ICH.