16: The Incidence of Neurological Complications in Pediatric Population Undergoing Extracorporeal Membrane Oxygenation Support in a Major Cardiac Centre in the UAE.

Introduction: Although many patients survive, significant neurologic complications like seizures, ischemic strokes and intracranial hemorrhage can occur during ECMO care (1-3). Sheikh Khalifa Medical City Cardiac Center is the biggest pediatric cardiac centre in UAE with an average of 200-250 surgical cases per year. Methods: We present a single center study that reviews the incidence of neurological complications in pediatric population who underwent ECLS support (Veno-arterial and Veno-venous) over a period of 4 years (2021-2024). Results: We had total of 73 cases supported on ECMO during the study period (average 18 cases/year). Of those, 62/73 were VA cases (85%) and 11/73 were VV cases (15%). The median age was 25 months, with a median of 7 days on ECMO. Those who were successfully weaned off were 41/62 (66%) and 10/11 (91%) in VA and VV ECMO groups respectively. Mortality rate was reported in 22/73 cases (30%). Our ECMO protocol recommends serial cranial Ultrasound scans in addition to the use of NIRS (Near Infraspectrometry) and Cerebral function monitoring where possible. Neurological complications in the study cohort were reported in 23 cases (31.5%) ranging from simple Intraventricular hemorrhage (IVH) Grade 1 to severe hypoxic brain insult or ischemia. 12/23 (52%) of those cases were successfully weaned off ECMO and had been discharged. Their average PICU length of stay, however was significantly longer compared to those ECMO survivors with no to minimal neurological insult (18 days versus 10 days, p=0.002). Those survivors are at risk for long term neurological complications affecting their neurodevelopmental outcomes. Conclusion: We therefore propose that a comprehensive pediatric and neonatal ECMO management program that incorporates multidisciplinary team is necessary to help minimize the long-term risks of neurological insults associated with ECMO, and provides an awareness of possible long-term ramifications.