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Brain MRI findings in pediatric patients post ECMO.

Neurologic complications can occur with ECMO due to several factors. Prior studies identified neonates as having unique risk factors and neuro-imaging findings post-ECMO. The aim of this study is to describe brain MRI findings of pediatric patients treated with ECMO. We conducted a retrospective study of non-neonatal pediatric patients who underwent a comprehensive brain MRI after ECMO, between January 2000 and July 2015. We identified 47 pediatric patients in the study cohort with a median age of 8 months (IQR 3-170mo) and a median ECMO run duration of 7.15 days (IQR 3.8-10.3d). Among indications for ECMO cannulation, 12(25.5%) were cardiac, 23(48.9%) were respiratory and 12(25.5%) were ECPR cannulations. There were 33(70.2%) VA cannulations of which 14(42%) were transthoracic cannulations. There were 13 patients (27.7%) with an overall incidence of stroke: 8 patients had exclusive ischemic strokes, 2 had hemorrhagic strokes and 3 with mixed types of stroke. The number of strokes in patients on VA ECMO was significantly decreased in patients undergoing transthoracic cannulation compared to peripheral cannulation (7% vs 42%, p=0.05). Further study will be used to identify risk factors for neurological injury after ECMO and to look for outcome predictors based on neuro-radiologic findings.