ECMO-/ECLS

2, toddler brains are 80% of their full grown size. There is less buoyancy and
therefore less protection than the mature brain with a smaller subarachnoid
space. Children, therefore, are subject to a higher rate of diffuse cerebral
edema and parenchymal injuries [6]. Guidelines were revised and released in
January of 2012 for the acute medical management of severe TBI in infants,
children, and adolescents [7,8].^ The guidelines provide a means for decreasing
variability in the care provided across centers but there is very little data from
well designed randomized controlled trials and therefore much of the
recommendations come from expert advice and retrospective data.
The vast majority of TBI in the United States is blunt or non-penetrating
trauma frequently due to a motor vehicle collision or fall. This type of injury
typically results in focal damage to the underlying brain (coup), and, in some
instances, contrecoup damage occurs from the rebound movement of the brain
within the skull. This is commonly seen with subdural hemorrhages with
associated cortical contusion. Blunt trauma will often lead to axonal injury or
shearing and is often coupled with vascular injury. This injury is classically
observed as petechial hemorrhages in white matter and commonly referred to
as diffuse axonal injury (DAI). The neurologic impact due to axonal shearing
can present as a transient loss of consciousness or as profound and persistent
neurologic deficits, even leading to death.
Concussions deserve mention but the management and treatment of this
disease is beyond the scope of this chapter. Concussions are described as
mild to moderate TBI without a hematoma or intracranial process. Classically