Neuroimaging and Neuropathologic Findings in Pediatric Patients with ECMO: An Imaging-Pathology Comparison.
Severe brain injury on autopsy consistently matched imaging scores of Neurologic Injury Severity ≥10
Neuroimaging and Neuropathologic Findings in Pediatric Patients with ECMO: An Imaging-Pathology Comparison.
Neurologic complications are a leading cause of morbidity and mortality in children supported with extracorporeal membrane oxygenation (extracorporeal membrane oxygenation).
We performed a retrospective, single-center cohort study of neonates and children (0-18 years) supported with extracorporeal membrane oxygenation (2009-2024) who underwent cerebral autopsy.
A total of 54 patients underwent neuropathologic evaluation; 26 had qualifying neuroimaging.
Neuropathology revealed frequent ischemic and hemorrhagic injuries, most commonly in the frontal lobes, deep grey matter, and temporal lobes.
Severe injury was more frequent in venoarterial extracorporeal membrane oxygenation and in infants/toddlers.
Discordance was observed in parieto-occipital, pontine, and cerebellar regions, where immunohistochemistry (GFAP, CD68) detected subtle injuries not visible with hematoxylin and eosin (H&E).
Structured imaging severity scoring, especially with CT, correlates strongly with neuropathology in pediatric decedents of extracorporeal membrane oxygenation.
Findings support Neurologic Injury Severity scoring as a surrogate for underlying pathology, while underscoring the need for refined histologic methods and adjunctive neuromonitoring to optimize neurologic surveillance.