Plasma Biomarkers of Brain Injury in Critically Ill Children Receiving Extracorporeal Membrane Oxygenation

作者：Matthew L. Friedman, M. J. Bell, Bonnie A. Brooks, Adam S. Himebauch, Asavari Kamerkar, Kerri L. LaRovere, Laura L. Loftis, Jose A. Pineda, Ahmed S. Said, Hitesh Sandhu, Martin Stengelin, Catherine Demos, Mark S. Wainwright, Alina N. West, Allan Barnes, Allen D. Everett, Ryan J. Felling, Sue J. Hong, Jennifer Roem, Cynthia F. Salorio, Derek K. Ng, Melania M. Bembea, Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network, Lucy Mulqueen, Jennifer Bonilla- Cartagena, Myra Lomeli, Hoa Bui, Cindee Levow, Shawn Dickey, Sonali Basu, Elyse Tomanio, Ashley Schaefer Barcikowski, Mackenzie Little, Kirsten Ryan, Betsy Tudor, Colleen Mennie, Kamala Simkhada, Lisa Hwang, Jacqueline Lee-Eng, Mikaela Morales, Maria Teresa Valenzuela, Nereyda Garcia, Misciel Macaraig, Lauren Camp, Brandy Vaughn, Jessie Archie-Dilworth, Pamela Stone, Christina Love, Matthew Ryan, Meghna Cacatte · 发表于：Archives of Pediatrics and Adolescent Medicine · 年份：2026 · DOI：10.1001/jamapediatrics.2026.0015 · 被引用次数：4 · 研究领域：Mechanical Circulatory Support Devices、Hemoglobin structure and function、Immune Response and Inflammation

Importance: Timely identification of acute brain injury (ABI) in children receiving extracorporeal membrane oxygenation (ECMO) support is critical for early neuroprotective interventions. Objectives: To determine if elevations in plasma glial fibrillary acidic protein (GFAP), neurofilament light chain (NfL), and tau levels in children receiving ECMO precede new ABI confirmed by neuroimaging, and if they are associated with mortality and functional outcomes. Design, Setting, and Participants: This was a prospective observational cohort study conducted from 2019 to 2023, with 18-month follow-up completed in 2025. Children aged 2 days to younger than 18 years at ECMO cannulation were recruited from 11 US children's hospitals. Study data were analyzed from May to August 2025. Exposures: GFAP, NfL, and tau measured in plasma samples collected serially during the ECMO course. Main Outcomes and Measures: Unfavorable short-term outcome was a composite of in-hospital mortality or discharge Pediatric Cerebral Performance Category score of 3 or greater with decline of at least 1 point from baseline. Unfavorable long-term outcome was a composite of mortality or Vineland Adaptive Behavior Scales, third edition, composite score less than 85 at 18 months after ECMO. Results: This study included 219 participants (224 ECMO courses; 1089 serial blood samples). Median age was 11 months (IQR, 30 days-9 years), and 121 (54%) were male. Among 60 ECMO courses with new ABI during the ECMO course, GF...