Original investigationCranial CT for Diagnosis of Intracranial Complications in Adult and Pediatric Patients During ECMO: Clinical Benefits in Diagnosis and Treatment1
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)
- et al.
Extracorporeal life support outcome for 128 pediatric patients with respiratory failure
J Ped Surg
(2000) - et al.
Neurologic outcome in children after extracorporeal membrane oxygenation: prognostic value of diagnostic tests
Pediatr Neurol
(2005) - et al.
Chest and abdominal CT during extracorporeal membrane oxygenation: clinical benefits in diagnosis and treatment
Acad Radiol
(2005) - et al.
A pilot investigation of mild hypothermia in neonates receiving extracorporeal membrane oxygenation (ECMO)
J Pediatr
(2004) - et al.
Developmental outcome of neonates treated with extracorporeal membrane oxygenation
J Pediatr Surg
(1990) - et al.
Extracorporeal life support: an overview
- et al.
Extracorporeal life supportThe University of Michigan experience
JAMA
(2000) - et al.
Extracorporeal circulation in neonatal respiratory failure: a prospective randomized study
Pediatrics
(1985) UK collaborative randomized trial of neonatal extracorporeal membrane oxygenation
Lancet
(1996)- et al.
Extra-corporeal membrane oxygenation for pediatric respiratory failure
Brit Med Bull
(1997)
Extracorporeal life support for 100 adult patients with severe respiratory failure
Ann Surg
High survival rate in 122 ARDS patients managed according to a clinical algorithm including extracorporeal membrane oxygenation
Int Care Med
High survival in adult patients with acute respiratory distress syndrome treated by extracorporeal membrane oxygenation, minimal sedation, and pressure supported ventilation
Int Care Med
ECLS Registry Report
Cited by (80)
Pediatric ECLS Neurologic Management and Outcomes
2023, Seminars in Pediatric SurgeryMultiple decompressive craniectomies and hematoma evacuation in a patient undergoing extracorporeal membrane oxygenation
2022, Interdisciplinary Neurosurgery: Advanced Techniques and Case ManagementNeurological Monitoring and Complications of Pediatric Extracorporeal Membrane Oxygenation Support
2020, Pediatric NeurologyCitation Excerpt :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.
Brain development in newborns and infants after ECMO
2024, World Journal of Pediatrics
- 1
The study was supported by the Swedish Heart Lung Foundation.