This retrospective, single-center study aimed to evaluate the risk factors for mortality in pediatric extracorporeal membrane oxygenation (EMO) patients. All pediatric and neonatal patients requiring EMO between 2014 to 2018 underwent a standardized continuous EEG neuromonitoring protocol at PICU. Sixty-six children required EMO support during this period. Four of such patients were excluded; one with EMO initiated at institutions other than PICU, and three due to lack of EEG data. In the remaining 62 patients, 72% of patients had exclusively electrographic seizures, 17% had seizures, of which 45% had status epilepticus.

A total of 33 patients died, of which 22 died during the EMO course, and one died three years after hospital discharge. The mean survival from EMO support initiation was 767 days. In multivariate analysis, increased risk of mortality was associated with the use of extracorporeal cardiopulmonary resuscitation, imaging findings of cerebral edema,  high lactate level, and prolonged deep hypothermic circulatory arrest. The seizures’ presence was associated with imaging findings of cerebral edema .

In conclusion, seizures are common in children that require EMO support, with a high rate of status epilepticus and electrographic seizures, as observed in prior studies. The presence of cerebral edema is both a risk factor for mortality and seizures. Other risk factors for mortality include high lactate levels, prolonged deep hypothermic circulatory arrest, and extracorporeal cardiopulmonary resuscitation.