• Giorgio Caturegli, Sung-Min Cho, Bartholomew White, and Liam L Chen.
• Neurosciences Critical Care, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD.
• Pediatr Crit Care Me. 2021 Mar 1; 22 (3): 297302297-302.

ObjectivesCharacterization of the types and timing of acute brain injury in infant autopsy patients after extracorporeal membrane oxygenation.DesignRetrospective cohort study.SettingSingle tertiary-care center.PatientsInfants supported on extracorporeal membrane oxygenation.Measurements And Main ResultsClinical and pathologic records were reviewed for infant extracorporeal membrane oxygenation patients who had undergone brain autopsy in a single center between January 2009 and December 2018. Twenty-four patients supported on venoarterial extracorporeal membrane oxygenation had postmortem examination with brain autopsy. Median age at extracorporeal membrane oxygenation initiation was 82 days (interquartile range, 11-263 d), median age at time of death was 20 weeks (interquartile range, 5-44 wk), and median extracorporeal membrane oxygenation support duration was 108 hours (interquartile range, 35-366 hr). The most common acute brain injury found at autopsy was hypoxic-ischemic brain injury (58%) followed by intracranial hemorrhage (29%). The most common types of intracranial hemorrhage were intracerebral (17%), subarachnoid (17%), and subdural (8%). Only five infants (21%) did not have acute brain injury. Correlates of acute brain injury included low preextracorporeal membrane oxygenation oxygen saturation as well as elevated liver enzymes, total bilirubin, and lactate on days 1 and 3 of extracorporeal membrane oxygenation. Gestational age, Apgar scores, birth weight, extracorporeal membrane oxygenation duration, anticoagulation therapy, and renal and hepatic impairments were not associated with acute brain injury.ConclusionsAcute brain injury was observed in 79% of autopsies conducted in infants supported on extracorporeal membrane oxygenation. Hypoxic-ischemic brain injury was the most common type of brain injury (58%), and further associations with preextracorporeal membrane oxygenation acute brain injury require additional exploration.Copyright © 2020 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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