ECMO-/ECLS

assessment remains essential (Table 2; Figure 8). This exam should be
performed, preferably before the administration of sedation and neuromuscular
blockade. Clinical symptoms suggestive of intracranial injury or elevated ICP
(Intracranial pressure) include coma, irritability, lethargy, emesis or seizures.
Physical exam findings associated with elevated ICP include frontal bossing,
enlarged heads, dilated scalp veins, sun-setting eyes, papilledema, and bulging
fontanelles. Attention should be paid to scalp lacerations, which may be the
source of shock in pediatric patients. Isotonic fluid should be given early during
the child’s assessment. Dextrose containing fluid should be avoided in the
early stages of resuscitation. Although pediatric patients are prone to
hypoglycemia, this is rare in the first phases of trauma. As hypoxia and
hypotension can cause secondary brain injury, this should be avoided in the
suspected head trauma. CT scan remains the gold standard diagnostic study.
Cervical spine images should also be obtained. There is an approximately 10%
association of cervical spine fractures associated with intracranial injuries [18].
TBI can predispose the pediatric patient to coagulopathy. In patients with
a GCS of 8 or less, 81% are coagulopathic and carry a worse prognosis [19].^
Additionally, hyperglycemia after TBI is associated with a higher mortality.
Glucose levels ≥ 300mg/dL upon admission were associated with death [20].^
Moreover, patients with hyperglycemia in the first 48 hrs after admission are
also associated with a worse prognosis [21].^ Serial CT scans may be
necessary to monitor the progression of the injury, particularly to monitor
cerebral edema. ICP increases drastically with small increases in intracranial