Extracorporeal membrane oxygenation (ECMO) augments cardiopulmonary function in critically ill children through use of large vessel cannulation and an external pump-oxygenator system. While advances in ECMO have allowed more children to survive otherwise fatal illnesses, the incidence of significant neurologic injury, such as cerebral ischemia, hemorrhage, or brain death has not improved.

Documented incidence of neurologic injury in ECMO survivors as determined by neuroimaging vary from 10% to 60%.^1–3 The occurrence of neurologic injury among non-survivors is unknown because intra-ECMO head imaging is not uniformly performed. Intra-ECMO neuroimaging is limited to head ultrasound (HUS) or computed tomography (CT) due to incompatibility of the ECMO circuit with magnetic resonance imaging (MRI). CT is the preferred intra-ECMO modality due to its ability to identify both ischemic and smaller hemorrhagic lesions.¹ MRI is more sensitive than CT in the detection of small foci of hemorrhage and acute ischemic stroke.^4–6 No data exists to compare CT and MRI for the detection of significant neurologic injury among ECMO patients. Therefore, we conducted a retrospective cohort study to test the hypothesis that detection of serious neurologic injury is similar between intra-ECMO CT imaging and post-ECMO MRI among children who required ECMO.