Files
Publication Date
5-2026
Disclaimer
These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly, these guidelines should guide care with the understanding that departures from them may be required at times.
Objective of the Clinical Pathway
This clinical pathway standardizes the approach to neuromonitoring for patients at high risk of acute brain injury, with the goal of early detection. The ECMO Neuromonitoring and Acute Brain Injury Clinical Pathway will outline special needs and considerations when an intracranial hemorrhage or ischemic brain injury is suspected, as the patient is supported on ECMO.
Target Users
Physicians (Intensivists [ICN, PICU, CICU], Neurosurgery, Neurology, Hematology, Fellows, Residents); Advanced Practice Neonatal/Pediatric Critical Care Nurses; Nurses (ICN, PICU, CICU); ECMO Support Team (ECMO Physician, ECMO Specialist, ECMO Core Team Specialist)
Clinical Questions Clinical Pathway
For pediatric patients on ECMO, is tissue plasminogen activator (tPA) a safe and effective treatment for acute ischemic stroke?
o A literature search was conducted with the assistance of a medical librarian on November 10, 2025, see Appendix 1 for search strategy and results. These results were shared with the committee on November 24, 2025. There is an absence of data modeling stroke management with tPA in this specific clinical context. Therefore, recommendations were not provided regarding the use of systemic tPA for arterial ischemic stroke management in pediatric patients receiving systemic anticoagulation while on ECMO •
For pediatric patients on ECMO, what are the timing and potential risk factors for hemorrhagic transformation after ischemic stroke?
o A literature search was conducted with the assistance of a medical librarian on November 10, 2025, see Appendix 2 for search strategy and results. These results were shared with the committee on November 24, 2025. Data specific to pediatric patients supported on ECMO is lacking. Therefore, generally known risk factors were considered when developing the clinical pathway
Disciplines
Pediatrics
Recommended Citation
Children's Mercy Kansas City, "Extracorporeal Membrane Oxygenation (ECMO) Neuromonitoring and Acute Brain Injury" (2026). Clinical Pathways.
https://scholarlyexchange.childrensmercy.org/clinical_pathways/37
Comments
Clinical Pathways are updated on a revision schedule. Primary files will always be the most current update. Previous revisions are available upon request from Children’s Mercy Library Services.
Finalized 3/2025, Algorithm revised: 8/2025; 11/2025; 5/2026
Clinical Pathways promote evidence based, safe, and high-value care for patients by providing clinical recommendations and standard processes. They are developed by multidisciplinary committees of subject matter experts, informed by methodical review of available evidence and consensus among committee members.