ECMO-/ECLS

vascular injury and can rule out life-threatening aortic or major vessel injury with
a negative predictive value approaching 100%.
Although immediate data may be obtained from a CT scan, this imaging
modality should be used selectively as there may be a 100-fold increase in
radiation dose when compared with a plain chest radiograph. Additionally,
imaging protocols used in the adult population do not necessarily apply to the
pediatric trauma patient. This is primarily because traumatic thoracic injury
patterns are different in children due to their compliant and flexible chest wall.
Major life-threatening thoracic injuries are rare in children and recent
retrospective reviews have demonstrated that routine screening CT scans of
the chest in the pediatric population, while more sensitive for injury detection in
the trauma setting, rarely alter patient management.
CT scan of the chest should be considered a supplemental study in blunt
thoracic trauma based on mechanism of injury, clinical exam, initial chest x-ray
findings, and hemodynamic stability. Patients who suffer high impact blunt
injury suggested by fractures to the spine, sternum, and shoulder girdle should
be evaluated by CT angiography to rule out associated major vascular injuries
or unstable spine fractures. In addition, children with radiographic findings of
an abnormal or widened mediastinum should prompt further investigation with a
CT aortogram. Rarely, significant blunt injury may be associated with
pneumomediastinum on chest x-ray, and CT scan of the chest may help
delineate the presence of esophageal rupture versus tracheobronchial tree
disruption. In the absence of significant clinical examination and chest x-ray