Utility of Routine Head Ultrasounds in Infants on Extracorporeal Life Support: When is it Safe to Stop Scanning?

Abstract

Intracranial hemorrhage (ICH) can be a devastating complication of extracorporeal life support (ECLS); however, studies on the timing of ICH detection by head ultrasound (HUS) are from 2 decades ago, suggesting ICH is diagnosed by day 5 of ECLS. Given advancements in imaging and critical care, our aim was to evaluate if the timing of ICH diagnosis in infants on ECLS support has changed. Patients <6 months old undergoing ECLS 2011-2020 at a tertiary care children's hospital were included. Primary outcome was timing of ICH diagnosis on HUS. Seventy-four infants underwent ECLS for cardiac (54%) or pulmonary (46%) indications. Venoarterial ECLS was most common (88%). Median ECLS duration was 6 days (range 1-26). Sixteen patients were diagnosed with ICH (21.6%), at a median of 2 days postcannulation (range 1-4). Nearly all were <4 weeks old at cannulation (93.8%). In conclusion, one-fifth of infants developed ICH diagnosed by HUS while on ECLS, all within the first 4 days of ECLS, consistent with previous literature. Despite advances in critical care and imaging technology, the temporality of ICH diagnosis in infants on ECLS is unchanged.

Figure 1:. Distribution of Intracranial Hemorrhage Diagnosis Timing on Extracorporeal Life Support.

ICH: intracranial hemorrhage; ECLS: extracorporeal life support.

Figure 2:. Timing of Initial Intracranial Hemorrhage and Progression to Higher Grade on Extracorporeal Life Support (ECLS).

White boxes indicate days patients were on ECLS; gray boxes indicate that the patient was no longer on ECLS. Note Patient 2 had their initial ICH diagnosed on ECLS day 4 and on the same say it progressed from Grade 2 to Grade 3.