Cranial CT for diagnosis of intracranial complications in adult and pediatric patients during ECMO: Clinical benefits in diagnosis and treatment.
OBJECTIVE
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.


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.


CONCLUSIONS
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.
Lidegran
Marika K
MK
Department of Pediatric Radiology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Institute for Molecular Medicine and Surgery, Karolinska Institute, SE-171 76 Stockholm, Sweden. marika.lidegran@karolinska.se
Mosskin
Mikael
M
Ringertz
Hans G
HG
Frenckner
Björn P
BP
Lindén
Viveka B
VB
D000293:Adolescent; D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging*; D001929:Brain Edema / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000532:radiotherapy* / Q000628:therapy; D002544:Cerebral Infarction / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D008875:Middle Aged; D012131:Respiratory Insufficiency / Q000628:therapy; D014057:Tomography, X-Ray Computed