Related Experiment Videos
Cerebrovascular lesions in infants and children dying after extracorporeal membrane oxygenation
1Department of Medicine, Medical College of Pennsylvania (Allegheny Campus), Allegheny General Hospital.
Insights
Extracorporeal membrane oxygenation (ECMO) treatment in children showed a higher frequency of brain lesions, including ischemic neuronal necrosis and cerebral infarcts. These findings highlight potential risks associated with ECMO therapy in pediatric patients.
Area of Science:
- Neuropathology
- Pediatric Critical Care
Background:
- Extracorporeal membrane oxygenation (ECMO) is a life-support intervention for severe cardiopulmonary failure in infants and children.
- Understanding the neuropathologic consequences of ECMO is crucial for improving patient outcomes.
Purpose of the Study:
- To review and tabulate neuropathologic autopsy findings in children who died after ECMO treatment.
- To compare the frequency of specific brain lesions in ECMO patients to a general autopsy population.
Main Methods:
- Retrospective review of autopsy findings over an 11-year period (1980-1991) at Children's Hospital of Pittsburgh.
- Analysis of brain examinations from 44 deceased pediatric patients who underwent ECMO therapy.
- Comparison of lesion frequencies with a general autopsy population.
Main Results:
- Higher frequencies of ischemic neuronal necrosis (50%), focal cerebral infarcts (50%), intracerebral hemorrhages (52%), and periventricular leukomalacia (41%) were observed in ECMO-treated patients.
- The incidence of these cerebrovascular lesions was similar between neonates and older children.
- Autopsy data was available for 70 of 94 deceased ECMO patients, with brain examination permission granted for 44.
Conclusions:
- Children treated with ECMO exhibit a notable frequency of ischemic and hemorrhagic brain lesions.
- These findings suggest potential risks of cerebrovascular damage associated with ECMO therapy.
- Further research into brain damage in ECMO survivors is warranted.
Abstract:
The neuropathologic autopsy findings of a group of infants and children at Children's Hospital of Pittsburgh who died after treatment with extracorporeal membrane oxygenation (ECMO) were reviewed and tabulated. The study surveyed an 11-year period (February, 1980 to May, 1991); of 268 children receiving ECMO therapy for severe cardiopulmonary failure, 94 patients died, 70 of whom were autopsied and permission for brain examination was granted in only 44. The frequency of ischemic neuronal necrosis (50%), focal cerebral infarcts (50%), intracerebral hemorrhages (52%), and periventricular leukomalacia (41%) was higher in this group of ECMO-treated patients than that observed in the general autopsy population from which the study patients were selected. The frequency of ischemic and hemorrhagic brain lesions was similar among neonates and older infants and children. This documentation of cerebrovascular lesions in children dying after ECMO may provide a better understanding of potential brain damage in the larger population of infants and children who survive this invasive procedure.