Safety and Feasibility of High-density Diffuse Optical Tomography for Longitudinal Brain Monitoring in Pediatric ECMO Patients

Extracorporeal membrane oxygenation (ECMO) provides life support for severe, reversible cardiac or respiratory failure but carries substantial risk of neurological complications. Pediatric ECMO patients are particularly vulnerable, with over half of survivors exhibiting abnormal neuroimaging findings following discharge. Currently available clinical neuroimaging tools are limited, offering either static anatomical snapshots (ultrasound, computed tomography) or sparse functional monitoring (electroencephalography, functional near infrared spectroscopy) with limited spatial specificity. High-density diffuse optical tomography (HD-DOT) addresses these limitations to provide noninvasive, longitudinal, wide-field measurements of changes in cortical oxygenation at the beside. Here, we investigate safety and feasibility for bedside longitudinal HD-DOT monitoring of cerebral oxygenation focusing on data collected over 20 days in seven pediatric ECMO patients. Results confirm the reliable acquisition of high-quality HD-DOT data without adverse events, establishing HD-DOT as a promising tool for continuous, and safe bedside neuroimaging in this population.