Imaging spectrum of extracorporeal membrane oxygenation related neurologic events in children

Area of Science:

• Pediatric critical care medicine
• Neuroradiology
• Extracorporeal life support

Background:

• Extracorporeal membrane oxygenation (ECMO) is a life-support measure for critically ill patients.
• Neurological complications are a significant concern in patients undergoing ECMO, impacting morbidity and mortality.
• Understanding imaging findings is crucial for managing these neurological complications.

Purpose of the Study:

• To evaluate the imaging findings in pediatric patients experiencing neurological complications associated with ECMO.
• To correlate imaging findings with ECMO duration and survival rates.
• To examine the impact of imaging timing (during ECMO vs. after weaning) on outcomes.

Main Methods:

• Retrospective evaluation of children (<18 years) who received ECMO and underwent cranial CT or MRI.
• Documentation of patient demographics, clinical presentation, and imaging findings.
• Analysis of the relationship between ECMO duration, survival, and imaging results, considering the timing of imaging.

Main Results:

• Twenty pediatric patients were included, with a median ECMO duration of 12.5 days and a 65% survival rate.
• Fourteen patients (70%) showed positive imaging findings, including ischemic stroke, hemorrhagic stroke, hypoxic-ischemic encephalopathy, posterior reversible encephalopathy syndrome (PRES), and cerebral vein thrombosis.
• No significant difference in ECMO duration or survival was found between patients with positive and unremarkable imaging findings.

Conclusions:

• Posterior reversible encephalopathy syndrome (PRES) was identified as an ECMO-related neurological event, alongside common thrombotic and hemorrhagic strokes.
• Prompt diagnosis and treatment of ECMO-associated neurological complications are facilitated by cross-sectional imaging.
• Radiologist awareness of potential complications during and after ECMO is vital for timely intervention.