Little is known on the long term neurodevelopmental impact of a cardiopulmonary arrest on neonates with intractable cardiorespiratory failure who are being treated with ECMO. We previously reported on survival and neurodevelopmental outcome in a cohort of ECMO treated neonates matched by diagnosis for arrest (AG) and non-arrest (NAG) status. The current study was undertaken to correlate the cranial CT scans with the neurodevelopmental outcome in the survivors of this cohort. CT scans were performed on the AG at a median of 15 days of age, and on the NAG at a median of 12 days of age. In the AG, CT scans were done at a median of 13 days post arrest. The timing of arrests included 27 prior to ECMO (including 11 at cannulation, and 3 infants with multiple arrests) and 2 post ECMO. At follow up, age 12 to 42 months, the discharge CT scans of 29/30 AG (32±12 months, Mean±SD) and 31/35 NAG (33±11 months) children were reviewed by a neuroradiologist who was blinded to patient arrest and outcome status. Major findings on CT included:*p=0.049 In the AG with CT findings of low perfusion injury (i.e. vascular border zone necrosis), all arrests occurred at cannulation. The one NAG infant with a low perfusion injury had profound intrapartum asphyxia and fetal bradycardia. On neurodevelopmental follow up, 3 infants were abnormal and 1 was suspect. In infants with CT findings of an infarct (i.e. necrosis in a vascular distribution), neurodevelopmental outcome included 1 child whose exam was normal, 2 suspect, and 4 abnormal. In conclusion, neonates meeting the criteria for ECMO, but who have also had an arrest are not at an increased risk for low perfusion injury to the brain over their non-arrest cohorts. The increased incidence of intracranial infarcts in this group deserves continued neurodevelopmental study. All infants with major findings on CT following treatment with ECMO are at very high risk for significant neurodevelopmental problems and require close long term follow up.Table

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