Continuous bedside neuroimaging using high-density diffuse optical tomography in a pediatric patient on extracorporeal support

Abstract

ABSTRACTBackgroundExtracorporeal membrane oxygenation (ECMO) provides life support for severe, reversible cardiac or respiratory failure, yet is associated with significant neurological risks including stroke. Currently available neuroimaging methods have limited sensitivity or specificity to detect early brain injury, have little real-time ability to assess interventions, and/or pose additional risks. Here, we present a case study of high-density diffuse optical tomography (HD-DOT) for bedside neuroimaging in pediatric ECMO.MethodsA young infant supported on ECMO following cardiac surgery underwent continuous HD-DOT imaging over a two-hour duration that included baseline support and a clamp trial to test the ability to separate from ECMO. After stringent data quality assessments, we estimated cortical parcel-based brain functional connectivity (FC), evaluated spatial correlations between neighboring temporal epochs throughout the recording to evaluate test-retest reliability of brain FC, and calculated paired t-tests between the brain-wide set of test-retest values to test for significant changes in brain FC.ResultsHigh-fidelity bedside HD-DOT data were acquired without disruptions to patient care. During the baseline period, we observed strong test-retest with consistent bilateral FC patterns. Significant disruptions in cortical FC reflected concurrent changes in cerebral blood flow during the clamp trial and persisted after ECMO resumed.ConclusionsOur results demonstrate the feasibility of continuous bedside HD-DOT neuroimaging in pediatric ECMO. HD-DOT can potentially provide clinically relevant information on cortical FC during ECMO support.