ECMO-/ECLS

Steroids are routinely used and supported in the management of non-
traumatic neurologic conditions. However, in the management of pediatric TBI,
current data indicates that treatment with steroids is not associated with
improved functional outcome, decreased mortality or reduced ICP [29, 31].
These studies have also noted trends of increased pneumonia and suppression
of endogenous cortisol levels. Given the lack of beneficial evidence and the
potential harm from these medications, corticosteroids are not recommended in
the management of pediatric TBI.
It is estimated that 21% to 42% of children with severe TBI will develop
refractory intracranial hypertension despite aggressive medical management.^8
Decompressive craniectomy, high-dose barbiturate therapy, hyperventilation,
lumbar drain placement, and the use of moderate hypothermia should be
considered in these patients. Early decompressive craniectomies has been
shown to provide improved outcomes in several small single-center studies [32-
33]. High doses of barbiturates are known to reduce ICP and have been used
in the management of increased ICP for decades. Their side effects limit their
current use to those patients with injuries refractory to first-line therapies as
evidence has been limited to several small case series [34, 35].Their use is
associated with hemodynamic instability therefore close monitoring is
imperative. Finally, therapeutic hypothermia may be considered as a second
line therapy as the benefits seen in animal models remains unproven in
humans. Data extrapolated from the adult literature indicate that hyperthermia
adversely affects TBI outcomes, and it may be advisable to consider passive