Early detection of neurologic injury and issues of rehabilitation after pediatric cardiac extracorporeal membrane oxygenation

Neurological impairment results in a significant population of children aft er extracorporeal membrane oxygenation (ECMO) for treatment of otherwise in tractable circulatory failure. Pre-ECMO hypoxia/ischemia, reperfusion injur y, and impaired cerebral perfusion during low output situations possibly ag gravated by harmful effects of apulsatile perfusion are discussed in terms of possible etiological reasons. To develop preventive strategies or to ena ble curative measure, early detection of neuronal injury seems mandatory. E lectroencephalographic surveillance and/or monitoring of evoked potentials and monitoring of cerebral oxygenation by means of near infrared spectrosco py or jugular venous bulb oxygen saturation, as well as measurements of ser um neuron specific enolase, S-100 protein, and brain type creatine kinase c an be employed clinically. To improve functional outcome following neuronal injury, early rehabilitation seems essential to minimize the resulting eff ects on physical, cognitive, and emotional development.