OBJECTIVES: 

This project aims to describe brain injuries on routine neuroimaging in a large single-center neonatal and pediatric cohort supported by extracorporeal membrane oxygenation. The study also aims to examine the association of these injuries with neurocognitive outcomes in survivors and identify laboratory findings associated with neurologic injury.

DESIGN: 

Retrospective observational single-center cohort study.

SETTING: 

Tertiary care PICU.

PATIENTS: 

Pediatric patients with noncardiac indications for extracorporeal membrane oxygenation supported by venoarterial or venovenous extracorporeal membrane oxygenation, with on-extracorporeal membrane oxygenation brain CT or postextracorporeal membrane oxygenation brain CT/MRI.

INTERVENTIONS: 

Extracorporeal membrane oxygenation support.

MEASUREMENTS AND MAIN RESULTS: 

Occurrence of brain injury on CT and MRI was reviewed; injuries were scored. Clinical and laboratory results associated with injury were identified. Survivor neurocognitive outcomes were obtained using the Pediatric Overall Performance Category scale and Pediatric Cerebral Performance Category scale. Of 132 imaged patients, 98 (74%) had radiological evidence of brain injury. Mean injury score was 6.5 (± 3.8). Head ultrasounds and clinician suspicion performed poorly in suspecting the presence of injury. Of 104 respondents to neurodevelopmental assessments, 61 (59%) had normal scores; 12.5%, 17%, and 11.5% had mild, moderate, or severe disability. A neuroimaging score greater than 10 was associated with an unfavorable outcome on the Pediatric Cerebral Performance Category (odds ratio, 3.4; p < 0.01) and Pediatric Overall Performance Category (odds ratio, 1.7; p < 0.05). Ischemic injury correlated with worse neurodevelopmental outcome. Preextracorporeal membrane oxygenation lactate, Vasoactive-Inotropic Scores, transaminitis, elevated bilirubin and creatinine levels, and thrombocytopenia were associated with injury occurrence.

CONCLUSIONS: 

Brain injury is frequent in extracorporeal membrane oxygenation patients, although the majority of survivors have favorable neurocognitive outcomes. More research is needed in order to understand the etiology of such injuries. Head ultrasound and clinician suspicion are not sensitive in detecting extracorporeal membrane oxygenation–related brain injuries. Protocolizing postextracorporeal membrane oxygenation imaging with brain MRI allows the identification of injuries and provision of timely neurocognitive intervention.

中文翻译：

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常规神经影像学：了解小儿体外膜氧合中的脑损伤*

目标： 

该项目旨在描述由体外膜氧合支持的大型单中心新生儿和儿科队列中常规神经影像学检查的脑损伤。该研究还旨在检查这些损伤与幸存者的神经认知结果之间的关联，并确定与神经损伤相关的实验室检查结果。

设计： 

回顾性观察性单中心队列研究。

环境： 

三级护理 PICU。

患者： 

具有体外膜氧合的非心脏适应症的儿科患者，通过体外膜氧合脑 CT 或体外膜氧合后脑 CT/MRI 支持静脉-动脉或静脉-静脉体外膜氧合。

干预措施： 

体外膜氧合支持。

测量和主要结果： 

回顾了 CT 和 MRI 上脑损伤的发生；受伤得分。确定了与损伤相关的临床和实验室结果。幸存者的神经认知结果是使用儿科整体表现类别量表和儿科大脑表现类别量表获得的。在 132 名影像患者中，98 名 (74%) 有脑损伤的放射学证据。平均伤害评分为 6.5 (± 3.8)。头部超声和临床医生怀疑在怀疑是否存在损伤方面表现不佳。在神经发育评估的 104 名受访者中，61 名 (59%) 得分正常；12.5%、17% 和 11.5% 的人有轻度、中度或重度残疾。神经影像学评分大于 10 与小儿脑功能类别的不良结果相关（比值比，3.4；p< 0.01）和儿科整体表现类别（比值比，1.7；p < 0.05）。缺血性损伤与较差的神经发育结果相关。体外膜氧合前乳酸、血管活性-肌力评分、转氨酶、胆红素和肌酐水平升高以及血小板减少与损伤发生有关。

结论： 

脑损伤在体外膜氧合患者中很常见，尽管大多数幸存者都有良好的神经认知结果。需要更多的研究来了解此类伤害的病因。头部超声和临床医生怀疑在检测体外膜氧合相关脑损伤方面不敏感。使用大脑 MRI 进行体外膜后氧合成像协议可以识别损伤并提供及时的神经认知干预。