Cerebral Near-Infrared Spectroscopy in Adult Patients Undergoing Veno-Arterial Extracorporeal Membrane Oxygenation

Pozzebon, Selene; Ortíz, Aaron Blandino; Franchi, Federico; Cristallini, Stefano; Belliato, Mirko; Lheureux, Olivier; Brasseur, Alexandre; Vincent, Jean‐Louis; Scolletta, Sabino; Créteur, Jacques; Taccone, Fabio Silvio

doi:10.1007/s12028-018-0512-1

Cited by 60 publications

(55 citation statements)

References 26 publications

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“…Cerebral near-infrared spectroscopy (NIRS) is a noninvasive monitoring technique that can provide continuous value of forehead regional oxygen tissue saturation, which represents the balance between cerebral oxygen delivery and cerebral oxygen consumption. A recent study reported the association between cerebral desaturation on NIRS with acute brain injury and mortality in VA-ECMO patients (41). NIRS could be an interesting and simple monitoring tool, introducing new therapeutic goals in VA-ECMO patients.…”

Section: Neurological Complicationsmentioning

confidence: 99%

Venoarterial extracorporeal membrane oxygenation in cardiogenic shock: indications, mode of operation, and current evidence

Chambrun

Bréchot

Combes

2019

Current Opinion in Critical Care

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Purpose of review: Temporary circulatory support (TCS) with venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used as a salvage therapy for patients with refractory cardiogenic shock. This article provides an overview of VA-ECMO principles, indications, management, complications and discusses the results of recent case series and trials. Recent findings: VA-ECMO is utilized as a bridge to "decision" that includes weaning after cardiac function recovery, transplantation, long-term mechanical circulatory support and withdrawal in case of futility. VA-ECMO is considered the first-line TCS since it allows rapid improvement in oxygenation, is less expensive, and is also suitable for patients with biventricular failure. Combining Impella or intra-aortic balloon pump support with VA-ECMO might decrease left ventricular pressure and improve outcomes. Massive pulmonary embolism, sepsis-associated cardiomyopathy, refractory cardiac arrest are among emerging indications for TCS. Summary: TCS have become the cornerstone of the management of patients with cardiogenic shock, although the evidence supporting their efficacy is limited. VA-ECMO is considered the first-line option, with a growing number of accepted and emerging indications. Randomized clinical trials are now needed to determine the place VA-ECMO in cardiogenic shock treatment strategies.

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Section: Neurological Complicationsmentioning

confidence: 99%

Venoarterial extracorporeal membrane oxygenation in cardiogenic shock: indications, mode of operation, and current evidence

Chambrun

Bréchot

Combes

2019

Current Opinion in Critical Care

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“…It can suggest a difference in the cerebral perfusion. A low near-infrared-spectroscopy is associated with a rapid onset poor outcome (risk of cerebral oedema development) and might be used to guide treatment in patients undergoing ECMO [142].…”

Section: Electroencephalogrammentioning

confidence: 99%

ERS International Congress, Madrid, 2019: highlights from the Respiratory Intensive Care Assembly

et al. 2020

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The Respiratory Intensive Care Assembly of the European Respiratory Society is delighted to present the highlights from the 2019 International Congress in Madrid, Spain. We have selected four sessions that discussed recent advances in a wide range of topics: from acute respiratory failure to cough augmentation in neuromuscular disorders and from extra-corporeal life support to difficult ventilator weaning. The subjects are summarised by early career members in close collaboration with the Assembly leadership. We aim to give the reader an update on the most important developments discussed at the conference. Each session is further summarised into a short list of take-home messages.

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“…However, a study by Zahraa found that there was no difference in central nervous system complications between pediatric respiratory failure patients supported on VA versus VV ECMO [20]. Differential hypoxia, where the arterial oxygen tension is lower in the upper half of the body than in the lower half, is a phenomenon occasionally seen in patients supported on peripheral VA ECMO that causes cerebral ischemia [21]. For pediatric patients on VA ECMO, the incidence of stroke was much lower for transthoracic or central cannulation compared to peripheral cannulation [22].…”

Section: Veno-arterial (Va) Versus Veno-venous (Vv)mentioning

confidence: 99%

“…When the probe is placed on the forehead, it measures cerebral oximetry. An analysis of adult patients on VA ECMO showed that cerebral desaturation was common and mortality higher for patients with cerebral desaturation compared to those without [21]. A sudden decrease in cerebral saturation can be associated with an acute neurological event, prompting further investigation.…”

Section: Cerebral Near Infra-red Spectroscopy (Nirs)mentioning

confidence: 99%

Neurologic Complications and Neuromonitoring on ECMO

Pinto¹

2019

Advances in Extracorporeal Membrane Oxygenation - Volume 3

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Extracorporeal membrane oxygenation is challenged by several potential complications. Adverse neurologic events such as intracranial hemorrhages, strokes, seizures, and brain death are among the most detrimental and even catastrophic of ECMO complications. There are several risk factors related to the patients, their underlying conditions and the therapy itself that predispose these patients to neurologic injuries. In this chapter, we review different types of neurological complications, the identification and management of which can be difficult. We will also discuss some of the currently available technologies for multimodal neurological monitoring as a complement to clinical exam.

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Cerebral Near-Infrared Spectroscopy in Adult Patients Undergoing Veno-Arterial Extracorporeal Membrane Oxygenation

Abstract: Monitoring of rSO could be considered as an interesting tool to monitor the brain of patients on VA-ECMO.

Cited by 60 publications

References 26 publications

Venoarterial extracorporeal membrane oxygenation in cardiogenic shock: indications, mode of operation, and current evidence

Venoarterial extracorporeal membrane oxygenation in cardiogenic shock: indications, mode of operation, and current evidence

ERS International Congress, Madrid, 2019: highlights from the Respiratory Intensive Care Assembly

Neurologic Complications and Neuromonitoring on ECMO

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