• Bixin Deng, Zhe Zhao, Tiechao Ruan, Ruixi Zhou, Chang'e Liu, Qiuping Li, Wenzhe Cheng, Jie Wang, Feng Wang, Haixiu Xie, Chenglong Li, Zhongtao Du, Wenting Lu, Xiaohong Li, Junjie Ying, Tao Xiong, Xiaotong Hou, Xiaoyang Hong, and Dezhi Mu.
• Department of Pediatric, West China Second University Hospital, Sichuan University, Chengdu, China.
• Crit Care. 2025 Jan 9; 29 (1): 1717.

BackgroundPatients supported by extracorporeal membrane oxygenation (ECMO) are at a high risk of brain injury, contributing to significant morbidity and mortality. This study aimed to employ machine learning (ML) techniques to predict brain injury in pediatric patients ECMO and identify key variables for future research.MethodsData from pediatric patients undergoing ECMO were collected from the Chinese Society of Extracorporeal Life Support (CSECLS) registry database and local hospitals. Ten ML methods, including random forest, support vector machine, decision tree classifier, gradient boosting machine, extreme gradient boosting, light gradient boosting machine, Naive Bayes, neural networks, a generalized linear model, and AdaBoost, were employed to develop and validate the optimal predictive model based on accuracy and area under the curve (AUC). Patients were divided into retrospective cohort for model development and internal validation, and one cohort for external validation.ResultsA total of 1,633 patients supported by ECMO were included in the model development, of whom 181 experienced brain injury. In the external validation cohort, 30 of the 154 patients experienced brain injury. Fifteen features were selected for the model construction. Among the ML models tested, the random forest model achieved the best performance, with an AUC of 0.912 for internal validation and 0.807 for external validation.ConclusionThe Random Forest model based on machine learning demonstrates high accuracy and robustness in predicting brain injury in pediatric patients supported by ECMO, with strong generalization capabilities and promising clinical applicability.© 2025. The Author(s).

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