Resistive Index Variability in Anterior Cerebral Artery Measurements During Daily Transcranial Duplex Sonography

Zamora, Carlos; Oshmyansky, Alexander; Bembea, Melania M.; Berkowitz, Ivor; Alqahtani, Eman; Liu, Shen; McGree, James; Stern, Steven; Huisman, Thierry A.G.M.; Tekes, Aylin

doi:10.7863/ultra.15.09046

Cited by 19 publications

(5 citation statements)

References 23 publications

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“…Right parietal cortex had greater disruptions in autoregulation than the left parietal cortex, which may be related to right-sided cannulation of the common carotid artery and internal jugular vein. 107 Obstructions in cephalic venous drainage may affect autoregulation by increasing the ICP. 49 Further studies are needed on the effects of carotid and jugular ECMO cannulae on cerebrovascular hemodynamics.…”

Section: Extracorporeal Membrane Oxygenation (Ecmo)mentioning

confidence: 99%

Neonatal cerebrovascular autoregulation

et al. 2018

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Cerebrovascular pressure autoregulation is the physiologic mechanism that holds cerebral blood flow (CBF) relatively constant across changes in cerebral perfusion pressure (CPP). Cerebral vasoreactivity refers to the vasoconstriction and vasodilation that occur during fluctuations in arterial blood pressure (ABP) to maintain autoregulation. These are vital protective mechanisms of the brain. Impairments in pressure autoregulation increase the risk of brain injury and persistent neurologic disability. Autoregulation may be impaired during various neonatal disease states including prematurity, hypoxic-ischemic encephalopathy (HIE), intraventricular hemorrhage, congenital cardiac disease, and infants requiring extracorporeal membrane oxygenation (ECMO). Because infants are exquisitely sensitive to changes in cerebral blood flow (CBF), both hypoperfusion and hyperperfusion can cause significant neurologic injury. We will review neonatal pressure autoregulation and autoregulation monitoring techniques with a focus on brain protection. Current clinical therapies have failed to fully prevent permanent brain injuries in neonates. Adjuvant treatments that support and optimize autoregulation may improve neurologic outcomes.

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Section: Extracorporeal Membrane Oxygenation (Ecmo)mentioning

confidence: 99%

Neonatal cerebrovascular autoregulation

et al. 2018

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“…In this overall context, CA impairment in critically ill patients treated by ECMO may be a key factor in the genesis of neurological complications. Recent preliminary studies using different methods have suggested an association with CA disorders and neurological outcome among children supported by ECMO (13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

Continuous Monitoring of Cerebral Autoregulation in Children Supported by Extracorporeal Membrane Oxygenation: A Pilot Study

et al. 2020

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ObjectiveCerebral Autoregulation (CA) impairment may pose a risk factor for neurological complications among children supported by Extra-Corporeal Membrane Oxygenation (ECMO). Our first objective was to investigate the feasibility of CA continuous monitoring during ECMO treatment and to describe its evolution over time. The second objective was to analyze the association between CA impairment and neurological outcome. DesignObservational prospective study.

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“…Monitoring technology has not been developed along with ECMO-related technologies, and monitoring of the central nervous system is particularly challenging. The head ultrasound was used in patients undergoing ECMO with several limitations ( 16 , 17 ), for example, this approach could not capture the neurologic imaging in pediatric patients with closed cranial fontanels and adult patients ( 8 ). Besides, it cannot be used for continuous monitoring.…”

Section: Discussionmentioning

confidence: 99%

Cerebral Tissue Regional Oxygen Saturation as a Valuable Monitoring Parameter in Pediatric Patients Undergoing Extracorporeal Membrane Oxygenation

et al. 2021

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Objective: Brain function monitoring technology for extracorporeal membrane oxygenation (ECMO) support has been developing quite slowly. Our objective was to explore the data distribution, variation trend, and variability of cerebral tissue regional oxygen saturation (CrSO2) in pediatric patients undergoing ECMO.Methods: Eight patients who received venoarterial ECMO (V-A ECMO) were included in our study. All of them accepted continuous CrSO2 monitoring by near-infrared spectroscopy (NIRS) within 12 h of ECMO initiation until ECMO wean. Differences in the CrSO2 distribution characteristic, the variation trend of daily CrSO2, and the variability of CrSO2 for the first 5 days following ECMO initiation were compared between survivors and non-survivors according to pediatric intensive care unit (PICU) mortality.Results: The percentage of time of CrSO2 <60% against the whole monitoring time was significantly lower in survivors in both hemispheres {right: 4.34% [interquartile range (IQR) = 0.39–8.55%] vs. 47.45% [IQR = 36.03–64.52%], p = 0.036; left: 0.40% [IQR = 0.01–1.15%] vs. 30.9% [IQR = 26.92–49.62%], p = 0.036}. Survivors had significantly higher CrSO2 on the first 4 days. Root mean of successive squared differences (RMSSD), the variability variable of CrSO2, was significantly lower in survivors (right: 3.29 ± 0.79 vs. 6.16 ± 0.67, p = 0.002; left: 3.56 ± 1.20 vs. 6.04 ± 1.44, p = 0.039).Conclusion: Lower CrSO2, CrSO2 <60% over a longer period of time, and higher fluctuation of CrSO2 are likely associated with PICU mortality in pediatric patients undergoing V-A ECMO.Clinical Trial Registry: URL: http://www.chictr.org.cn/showproj.aspx?proj=46639, trial registry number: ChiCTR1900028021.

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Resistive Index Variability in Anterior Cerebral Artery Measurements During Daily Transcranial Duplex Sonography

Abstract: Resistive index variability of 10% or greater on any day had a statistically significant risk of cerebrovascular complication development. Extracorporeal membrane oxygenation cannulation at younger than 3 days conferred an increased risk of cerebrovascular complications.

Cited by 19 publications

References 23 publications

Neonatal cerebrovascular autoregulation

Neonatal cerebrovascular autoregulation

Continuous Monitoring of Cerebral Autoregulation in Children Supported by Extracorporeal Membrane Oxygenation: A Pilot Study

Cerebral Tissue Regional Oxygen Saturation as a Valuable Monitoring Parameter in Pediatric Patients Undergoing Extracorporeal Membrane Oxygenation

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