In 2021, Danielle deCampo, MD, Ph.D. of the Children’s Hospital of Philadelphia, and her research team published a study in the American Epilepsy Society called “Continuous EEG (cEEG) Protocol Improves Detection of Seizure Onset in Children on Extracorporeal Membrane Oxygenation (ECMO): A Quality Improvement Project”.
The team knew that seizures were a “significant complication for pediatric patients requiring extracorporeal membrane oxygenation care”. These seizures have been associated with increased mortality in pediatric patients, as well as neurodevelopmental issues.
There were no guidelines for the use of continuous EEG monitoring in these young patients who are undergoing ECMO. Still, there have been efforts to attempt to have the cEEG start earlier. It is known that most of the time, seizures will occur in these patients within the first 24 to 48 hours after cannulation. The research team set up a protocol for pediatric ECMO, ensuring that it would improve the time to begin cEEG to detect seizures. The study was meant to see whether the goals they put forth were met.
What Were The Methods Used?
This was a retrospective study completed at just one location—John Hopkins Children Center. The team reviewed the cEEGs of patients who had gone through monitoring while on ECMO between April 5, 2014, and June 27, 2020. The team initiated its protocol in April 2019.
What did the protocol require? It asked that the cEEG monitoring be started on any ECMO patient as soon as possible from the moment they were cannulated. They also required that the cEEG be performed for at least 72 hours. Before the implementation of the protocol, the only time cEEG was used would be when there was a suspicion of seizures. This meant that before the protocol, some pediatric patients were not being monitored and may have suffered from seizures without the doctors being aware.
Researchers say the study was focusing on two major questions. First, “does protocol implementation decrease time from ECMO cannulation to cEEG initiation?”, and second, “do the majority of seizures occur early after ECMO initiation?”.
What Were The Results?
The cohort included 50 patients. Most of the patients were infants. They accounted for 76% of the patients. They analyzed 33 pre-protocol cEEGs and 18 post-protocol cEEGs. There was one patient that has two ECMO runs.
They found that after implementing the protocol, more patients were having their cEEG started within 24 hours after cannulation. They found that there “was no significant difference between groups for ECMO cannulation to seizure detection.” But they did find that the pre-protocol group had 15 times greater odds of having ongoing seizures at the start of the cEEG compared to the post-protocol group in which seizure onset was captured after cEEG initiation.”
When they compared “all seizures pre-protocol to those post-protocol, there was a significant difference in the median interval between cEEG recording start time and seizure detection, with ongoing seizures at cEEG initiation in the pre-protocol group, compared to seizures detected at 42 hours post.”
What Should This Mean For The Future?
The study was able to show that with the protocol implemented, it meant faster clinical care and that cEEG was started faster. It also meant that there were more cases where seizures were recorded immediately at onset. With protocols like this added to more facilities, it has the potential for medical professionals to intervene earlier, helping to prevent seizures, and when they do occur, treat them right away. It can also allow doctors to obtain data that could help to predict seizures and changes in the pediatric patient’s condition.