Elsevier

Academic Radiology

Volume 14, Issue 1, January 2007, Pages 62-71
Academic Radiology

Original investigation
Cranial CT for Diagnosis of Intracranial Complications in Adult and Pediatric Patients During ECMO: Clinical Benefits in Diagnosis and Treatment1

https://doi.org/10.1016/j.acra.2006.10.004Get rights and content

Rationale and Objectives

To evaluate the clinical utility of cranial computed tomography (CT) in pediatric and adult patients during ongoing extracorporeal membrane oxygenation (ECMO) treatment from acute respiratory failure and to assess the frequency of intracranial hemorrhage (ICH) and infarction during the treatment.

Materials and Methods

The medical records of 123 consecutive patients, 54 children (ages 3 months–17 years) and 69 adults (ages 18–62 years), treated with ECMO over a 10-year period were searched for cranial CT performed during ECMO. Indications for CT, CT findings, impact on clinical management, and patient outcome were noted. In addition, all CT scans were reviewed for the frequency of ICH or infarction.

Results

Seventy-eight patients had cranial CT while on ECMO. ICH or cerebral infarction were detected in 45 (37%) of the 123 patients. Eighteen patients (15%) had focal hemorrhage, 11 (9%) focal infarction, and 16 (13%) general brain edema. In 16 of the 45 patients, the CT findings were decisive to withdraw the ECMO treatment. Five patients were weaned from ECMO, and in four patients the findings motivated cranial surgery during ECMO. In the remaining 20 patients with less extended intracranial pathology, the ECMO treatment was continued with high survival.

Conclusion

Cranial CT has an important role during ECMO treatment to reveal or exclude severe intracranial complications where ECMO treatment should be discontinued. Less severe complications have a favorable prognosis with continued treatment. Our study suggests an underreporting of intracranial complications in adults and pediatric patients on ECMO because of low utilization of neuroimaging.

Section snippets

Patients and Study Design

During a 10-year period (May 1994–December 2004), 54 children (ages 3 months–17 years) and 69 adults (18–62 years of age) were treated with ECMO at our institution because of acute respiratory failure. The descriptive data including age, gender, diagnosis, cannulation type, time on ECMO, and outcome for these 123 patients are listed in Table 1. Their records were searched for a history of cranial CT performed during ECMO. Seventy-eight (63%) of the 123 patients had been examined with cranial CT

CT Findings

During the study time, 123 patients were treated with ECMO. Seventy-eight (63%) patients were examined with cranial CT on one ore more occasions during the ECMO treatment. More precisely, 47 of the 69 adults (68%) and 31 of the 54 children (57%) had cranial CT while on ECMO.

In 58% of these patients (45 of 78), clinical neurologic symptoms (seizures, focal weakness, pathologic pupillary response, or a delay in awakening from sedation) were stated as indication for the CT examination. The

Discussion

ICH and cerebral infarction during ECMO treatment are not uncommon and often involve a poor prognosis for survival. To prevent or reduce cerebral damage and to guide further treatment, early diagnosis of cerebral complications is important. However, as a result of sedation and sometimes pharmacologic paralysis, patients on ECMO are clinically difficult to evaluate. Cranial US is routinely used in neonates on ECMO, whereas methods available for diagnosis of cerebral lesions in older children and

References (29)

  • S. Kolla et al.

    Extracorporeal life support for 100 adult patients with severe respiratory failure

    Ann Surg

    (1997)
  • K. Lewandowski et al.

    High survival rate in 122 ARDS patients managed according to a clinical algorithm including extracorporeal membrane oxygenation

    Int Care Med

    (1997)
  • V. Lindén et al.

    High survival in adult patients with acute respiratory distress syndrome treated by extracorporeal membrane oxygenation, minimal sedation, and pressure supported ventilation

    Int Care Med

    (2000)
  • ECLS Registry Report

    (2006)
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      The use of head CT is limited by the need for transport (unless portable CT is available),94 exposure to radiation, and relative insensitivity to early ischemic injury. Recent studies have shown higher detection rates of ischemic stroke and ICH with more active CT use, reflecting the possible underreporting in centers with less-frequent imaging.55,69 Advantages of CT include a full field of view of the brain, operator independence, and excellent detection of ICH.

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    1

    The study was supported by the Swedish Heart Lung Foundation.

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