Imaging of cerebral complications of extracorporeal membrane oxygenation in infants with congenital heart disease \u2014 ultrasound with multimodality correlation

Patricia Svrckova,Riwa Meshaka,Kshitij Mankad,Catherine M Owens,Sandra Gala-Peralta,Melanie Holtrup,Angela Aramburo,Farhat Kazmi,Thomas Semple

doi:10.1007/s00247-019-04603-1

Abstract

Cranial ultrasound on neonatal intensive care units is generally performed by intensive care physicians, but radiologists often provide this crucial bedside test to children on specialist paediatric cardiac intensive care units. On a paediatric cardiac intensive care unit, complex congenital cardiac conditions are commonly encountered in both pre- and postoperative scenarios, often with the use of extracorporeal membrane oxygenation (ECMO), which both increases the risks of a number of neurologic complications and results in significant changes in vascular physiology. The aim of this pictorial essay is to discuss cranial ultrasound technique, demonstrate the changes in Doppler flow profiles resulting from veno-arterial extracorporeal membrane oxygenation and congenital cardiac conditions, and illustrate commonly encountered intracranial complications of extracorporeal membrane oxygenation support in congenital cardiac care.

Highlights

In the United Kingdom, most cranial ultrasound (US) examinations are performed in the context of prematurity, by neonatal intensive care physicians
Outside of the few centres employing mobile CT units, this leaves ultrasound as the only immediately available modality. The aim of this pictorial review was to illustrate the US appearance of common and less common intracranial pathologies encountered in neonates and infants with congenital heart diseases, before, during and after receiving extracorporeal membrane oxygenation (ECMO) support
Intracranial haemorrhage is the most frequent neurologic complication in neonates receiving ECMO support [11], the majority of cases occurring within 72 h of initiation of ECMO support [6]

Summary

Introduction

In the United Kingdom, most cranial ultrasound (US) examinations are performed in the context of prematurity, by neonatal intensive care physicians. Veno-arterial extracorporeal membrane oxygenation (ECMO) is commonly used as a form of periprocedural support in neonates with complex congenital heart diseases.

Results

Conclusion