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

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

Lidegran, Marika (author): Karolinska Institutet

Mosskin, Mikael (author): Karolinska Institutet

Ringertz, Hans, 1939- (author): Karolinska Institutet

Frenckner, Björn (author): Karolinska Institutet

Lindén, Viveka (author): Karolinska universitetssjukhuset, Stockholm

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Netherlands : Elsevier BV, 2007
2007
English.
In: Academic Radiology. - Netherlands : Elsevier BV. - 1076-6332 .- 1878-4046. ; 14:1, s. 62-71

Related links:: https://urn.kb.se/re...; show more...; https://doi.org/10.1...; http://kipublication...; show less...

Journal article (peer-reviewed)

Abstract Subject headings

RATIONALE AND OBJECTIVES: 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. MATERIALS AND 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. CONCLUSION: 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.

Keyword

Extracorporeal membrane oxygenation (ECMO)
computed tomography (CT)
intracharanial hemorrhage (ICH)
cerebral infarction
MEDICINE
MEDICIN

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By the author/editor: Lidegran, Marika; Mosskin, Mikael; Ringertz, Hans, ...; Frenckner, Björn; Lindén, Viveka

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By the university: Linköping University; Karolinska Institutet

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