Can we reduce the risk of neurological injury in critically ill children on initiation of ECLS? A narrative review of potential modifiable factors

N Joram¹, R R Thiagarajan², M Bembea³, S M Cho^{4

5}, A M Guerguerian⁶, R Lorusso⁷, A Polito⁸, L Raman⁹, E Sanford¹⁰, N Shah¹¹, A Zaaqoq¹², A Hoskote¹³, M Di Nardo¹⁴; Euro-ELSO Working Group on Neurologic Monitoring and Outcome

Affiliations

¹ Pediatric Intensive Care Unit, University Hospital of Nantes, Nantes, France.
² Division of Cardiac Critical Care, Department of Cardiology, Boston Children's Hospital, Boston, MA, USA.
³ Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁴ Neuroscience Critical Care Division, Departments of Neurology, Neurosurgery, and Anaesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁵ Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁶ Department of Critical Care Medicine, The Hospital for Sick Children, University of Toronto, ON, Canada.
⁷ Cardiothoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.
⁸ Pediatric Intensive Care Unit, Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospital, Geneva, Switzerland.
⁹ Department of Pediatrics, Childrens Health, Dallas, University of Texas Southwestern Medical Center, Dallas, TX, USA.
¹⁰ Department of Pediatric Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
¹¹ Department of Pediatrics, Washington University in St Louis, St Louis, MO, USA.
¹² University of Virginia, Charlottesville, VA, USA.
¹³ Department of Cardiac Intensive Care, Heart and Lung Directorate, Great Ormond Street Hospital for Children NHS Foundation Trust, & UCL, Institute of Cardiovascular Science London, UK.
¹⁴ Pediatric Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.

PMID: 40263906
DOI: 10.1177/02676591251329555

Review

Can we reduce the risk of neurological injury in critically ill children on initiation of ECLS? A narrative review of potential modifiable factors

N Joram et al. Perfusion. 2025 Apr.

. 2025 Apr;40(1_suppl):29S-38S.

doi: 10.1177/02676591251329555. Epub 2025 Apr 22.

Authors

Affiliations

¹ Pediatric Intensive Care Unit, University Hospital of Nantes, Nantes, France.
² Division of Cardiac Critical Care, Department of Cardiology, Boston Children's Hospital, Boston, MA, USA.
³ Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁴ Neuroscience Critical Care Division, Departments of Neurology, Neurosurgery, and Anaesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁵ Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁶ Department of Critical Care Medicine, The Hospital for Sick Children, University of Toronto, ON, Canada.
⁷ Cardiothoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.
⁸ Pediatric Intensive Care Unit, Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospital, Geneva, Switzerland.
⁹ Department of Pediatrics, Childrens Health, Dallas, University of Texas Southwestern Medical Center, Dallas, TX, USA.
¹⁰ Department of Pediatric Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
¹¹ Department of Pediatrics, Washington University in St Louis, St Louis, MO, USA.
¹² University of Virginia, Charlottesville, VA, USA.
¹³ Department of Cardiac Intensive Care, Heart and Lung Directorate, Great Ormond Street Hospital for Children NHS Foundation Trust, & UCL, Institute of Cardiovascular Science London, UK.
¹⁴ Pediatric Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.

PMID: 40263906
DOI: 10.1177/02676591251329555

Abstract

Neurological morbidity and mortality remain high in children requiring extracorporeal membrane oxygenation (ECMO). Although the severity of illness at the time of ECMO initiation and the nature of the underlying disease are strongly linked to the development of acute brain injury, several important factors are associated with neurological complications during ECMO support. Many of these factors, particularly those encountered during the early phase of ECMO initiation (first 24 hours), may be modifiable and represent potential targets for interventional studies aiming for improvement of neurological outcomes in pediatric ECMO patients. In this review from the European Extracorporeal Life Support Organization (EuroELSO) Working Group on Neurologic Monitoring and Outcome, we aim to summarize current knowledge on modifiable factors associated with brain injury during ECMO and their potential impact on outcome.

Keywords: ECMO; children; initiation of ECLS; neurological injury; outcome.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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Can we reduce the risk of neurological injury in critically ill children on initiation of ECLS? A narrative review of potential modifiable factors

Affiliations

Can we reduce the risk of neurological injury in critically ill children on initiation of ECLS? A narrative review of potential modifiable factors

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical