{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T15:32:04Z","timestamp":1788449524737,"version":"build-2803163510"},"reference-count":36,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2023,9,11]],"date-time":"2023-09-11T00:00:00Z","timestamp":1694390400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,9,11]],"date-time":"2023-09-11T00:00:00Z","timestamp":1694390400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000968","name":"American Heart Association","doi-asserted-by":"publisher","award":["19CDA34760291"],"award-info":[{"award-number":["19CDA34760291"]}],"id":[{"id":"10.13039\/100000968","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Neurocrit Care"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Extracorporeal membrane oxygenation (ECMO) provides lifesaving support to critically ill patients who experience refractory cardiopulmonary failure but carries a high risk for acute brain injury. We aimed to identify characteristics reflecting acute brain injury in children requiring ECMO support.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This is a prospective observational study from 2019 to 2022 of pediatric ECMO patients undergoing neuromonitoring, including continuous electroencephalography, cerebral oximetry, and transcranial Doppler ultrasound (TCD). The primary outcome was acute brain injury. Clinical and neuromonitoring characteristics were collected. Multivariate logistic regression was implemented to model odds ratios (ORs) and identify the combined characteristics that best discriminate risk of acute brain injury using the area under the receiver operating characteristic curve.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Seventy-five pediatric patients requiring ECMO support were enrolled in this study, and 62 underwent neuroimaging or autopsy evaluations. Of these 62 patients, 19 experienced acute brain injury (30.6%), including seven (36.8%) with arterial ischemic stroke, four (21.1%) with hemorrhagic stroke, seven with hypoxic-ischemic brain injury (36.8%), and one (5.3%) with both arterial ischemic stroke and hypoxic-ischemic brain injury. A univariate analysis demonstrated acute brain injury to be associated with maximum hourly seizure burden (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.021), electroencephalographic suppression percentage (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.022), increased interhemispheric differences in electroencephalographic total power (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.023) and amplitude (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.017), and increased differences in TCD Thrombolysis in Brain Ischemia (TIBI) scores between bilateral middle cerebral arteries (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.023). Best subset model selection identified increased seizure burden (OR\u2009=\u20092.07, partial\n                      <jats:italic>R<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.48,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.013), increased quantitative electroencephalographic interhemispheric amplitude differences (OR\u2009=\u20092.41, partial\n                      <jats:italic>R<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.48,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.013), and increased interhemispheric TCD TIBI score differences (OR\u2009=\u20094.66, partial\n                      <jats:italic>R<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.49,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006) to be independently associated with acute brain injury (area under the receiver operating characteristic curve\u2009=\u20090.92).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Increased seizure burden and increased interhemispheric differences in both quantitative electroencephalographic amplitude and TCD MCA TIBI scores are independently associated with acute brain injury in children undergoing ECMO support.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s12028-023-01836-9","type":"journal-article","created":{"date-parts":[[2023,9,11]],"date-time":"2023-09-11T15:07:43Z","timestamp":1694444863000},"page":"759-768","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Neurophysiologic Features Reflecting Brain Injury During Pediatric ECMO Support"],"prefix":"10.1007","volume":"40","author":[{"given":"Damla","family":"Hanalioglu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. \u2019Hamed","family":"Temkit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kara","family":"Hildebrandt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"MackDiaz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary","family":"Goldstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shefali","family":"Aggarwal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5396-2559","authenticated-orcid":false,"given":"Brian","family":"Appavu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,9,11]]},"reference":[{"key":"1836_CR1","doi-asserted-by":"publisher","first-page":"422","DOI":"10.1055\/s-0041-1726284","volume":"41","author":"G Chiarini","year":"2021","unstructured":"Chiarini G, Cho SM, Whitman G, et al. 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Dr. Appavu also received speaking honoraria from Natus for two webinar presentations.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of Interest"}},{"value":"The Institutional Review Board (No. 19-257) approved this study (approval date 05\/16\/2019). Written informed consent was obtained for all enrolled patients. All procedures were followed in accordance with the ethical standards of the Institutional Review Board at Phoenix Children\u2019s Hospital.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical Approval\/Informed Consent"}}]}}