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.

The authors have declared no competing interest.

This study was supported by funding from the Childrens Discovery Institute at St. Louis Childrens Hospital (CDI-II-2021-953-2) and the American Heart Association (AHA 25PRE1194156 AHA 25CSA1421325)

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Human Research Protections Office Institutional Review Board of Washington University School of Medicine gave ethical approval for this work

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↵† Co-First Author

↵* Co-Senior Author

All data produced in the present study are available upon reasonable request to the authors