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Abstract

Introduction: The incidence of electrographic seizures or nonconvulsive status epilepticus (NCSE), and the effect of such seizures in children treated with extracorporeal cardiac life support (ECLS) is not known. We investigated the occurrence of electrographic abnormalities including asymmetries in amplitude or frequency of the background rhythm and interictal activity in children undergoing ECLS, and their association with seizures. We compared mortality and radiologic evidence of neurologic injury between patients with seizures and those without seizures detected during continuous electroencephalography (cEEG) monitoring. Hypothesis: Seizures are common in children undergoing ECLS. Methods: Retrospective review of pediatric patients up to 18-years of age, who had underwent both ECLS and cEEG monitoring between the years 2006 – 2011 at a single academic medical center. Results: Data from 19 patients were analyzed. Seizures occurred in 4 patients (21%), and were exclusively nonconvulsive in 3. Two of these four patients (50%) had nonconvulsive status epilepticus (NCSE). Interictal discharges on EEG were associated with seizures (OR 19.5, p = 0.03, 95% CI 1.29 – 292.75). Only 50% of the seizures were detected in the first hour of monitoring, while all seizures were detected within 24 hours. All patients with seizures had structural abnormalities seen on neuroimaging. The presence of seizures was not significantly associated with increased mortality. Conclusions: Seizures were common in this group of selected children during ECLS, and most seizures are nonconvulsive. In patients undergoing ECLS, clinical features are unreliable indicators of the presence of seizures. While seizures were not associated with increased mortality in this group, further prospective studies are needed to assess the long-term morbidity associated with seizures during ECLS.