Work

Predictors of Brain Infarction in Pediatric Patients During Extracorporeal Membrane Oxygenation

Year: 2026

Type: article

Abstract: INTRODUCTION: Brain infarction (BI) is a severe complication of extracorporeal membrane oxygenation (ECMO) with high morbidity and mortality. We aimed to determine the incidence of BI and identify predictors in pediatric patients receiving ECMO. METHODS: We performed a retrospective single-center cohort study including patients aged 29 days to < 18 years who underwent ECMO treatment at a tertiary center between January 2010 and October 2023. The primary outcome was BI during ECMO. Predictors of BI were analyzed using logistic regression. RESULTS: Among 179 included patients, BI was diagnosed in 51 (28%). Multivariable logistic regression identified venoarterial (VA) ECMO (OR 3.82, 95% CI 1.45-10.08; p = 0.007) and higher pre-ECMO arterial lactate (per mmol/L increase, OR 1.11, 95% CI 1.02-1.20; p = 0.01) as independent predictors of BI. The 30-day mortality was 67% among patients with BI compared with 15% among those without BI (p < 0.001). CONCLUSION: Brain infarction was more common than in most prior reports and was associated with high short-term mortality. VA ECMO mode, compared with venovenous ECMO, and higher pre-ECMO arterial lactate were independent predictors of BI. These findings support enhanced, standardized neurological monitoring and a liberal early brain CT strategy in pediatric ECMO patients, particularly those supported with VA ECMO.

Source: Artificial Organs

DOI: 10.1111/aor.70115