Cerebral Pathophysiology in Extracorporeal Membrane Oxygenation: Pitfalls in Daily Clinical Management

Kazmi, Syed Omar; Sivakumar, Sanjeev; Karakitsos, Dimitrios; Alharthy, Abdulrahman; Lazaridis, C.

doi:10.1155/2018/3237810

Cited by 40 publications

(36 citation statements)

References 132 publications

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“…Severity of illness and factors associated with critical illness in general have been described to determine outcome following neonatal critical illness (2). In addition, ECMO treatment may further complicate neurodevelopment by affecting cerebral blood flow and subsequently cerebral autoregulation (28). However, a conclusive cause-effect relationship with ECMO has not been established (28).…”

Section: Pathophysiological Mechanisms Underlying Neurodevelopmentalmentioning

confidence: 99%

Neurocognitive Outcome After Treatment With(out) ECMO for Neonatal Critical Respiratory or Cardiac Failure

Schiller

Tibboel

2019

Front. Pediatr.

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Over the years, it has become clear that children growing up after neonatal critical illness are at high risk of long-term neurocognitive deficits that impact their school performance and daily life activities. Although the pathophysiological mechanisms remain largely unknown, emerging evidence seems to suggest that long-term neuropsychological deficits following neonatal critical illness are not associated with the type of treatment, such as extracorporeal membrane oxygenation (ECMO), but rather with underlying disease processes. In this review, neurocognitive outcome and brain pathology following neonatal critical respiratory and cardiac illness, either treated with or without ECMO, are described and compared in order to gain insight into potential underlying pathophysiological mechanisms. Putting these findings together, it becomes apparent that both children with complex congenital heart disease and children who survived severe respiratory failure are at risk of neurocognitive deficits later in life. Neurorehabilitation strategies, such as Cogmed working-memory training, are discussed. While prevention of neurocognitive deficits altogether should be strived for in the future, this is not realistic at this moment. It is therefore of great importance that children growing up after neonatal critical illness receive long-term care that includes psychoeducation and personalized practical tools that can be used to improve their daily life activities.

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Section: Pathophysiological Mechanisms Underlying Neurodevelopmentalmentioning

confidence: 99%

Neurocognitive Outcome After Treatment With(out) ECMO for Neonatal Critical Respiratory or Cardiac Failure

Schiller

Tibboel

2019

Front. Pediatr.

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“…Neurologic impairments are frequent during ECMO therapy [7,8,9,12,13,14,15], mainly affecting the central nervous system such as ischemic stroke (IS) or intracerebral hemorrhage (ICH). These complications lead to increased ICU and hospital stay, morbidity, and mortality [16,17,18].…”

Section: Discussionmentioning

confidence: 99%

Longtime Neurologic Outcome of Extracorporeal Membrane Oxygenation and Non Extracorporeal Membrane Oxygenation Acute Respiratory Distress Syndrome Survivors

Harnisch¹,

Riech²,

Mueller

et al. 2019

JCM

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Neurologic complications following acute respiratory distress syndrome (ARDS) are well described, however, information on the neurologic outcome regarding peripheral nervous system complications in critically ill ARDS patients, especially those who received extracorporeal membrane oxygenation (ECMO) are lacking. In this prospective observational study 28 ARDS patients who survived after ECMO or conventional nonECMO treatment were examined for neurological findings. Nine patients had findings related to cranial nerve innervation, which differed between ECMO and nonECMO patients (p = 0.031). ECMO patients had severely increased patella tendon reflex (PTR) reflex levels (p = 0.027 vs. p = 0.125) as well as gastrocnemius tendon reflex (GTR) (p = 0.041 right, p = 0.149 left) were affected on the right, but not on the left side presumably associated with ECMO cannulation. Paresis (14.3% of patients) was only found in the ECMO group (p = 0.067). Paresthesia was frequent (nonECMO 53.8%, ECMO 62.5%; p = 0.064), in nonECMO most frequently due to initial trauma and polyneuropathy, in the ECMO group mainly due to impairments of N. cutaneus femoris lateralis (4 vs. 0; p = 0.031). Besides well-known central neurologic complications, more subtle complications were detected by thorough clinical examination. These findings are sufficient to hamper activities of daily living and impair quality of life and psychological health and are presumably directly related to ECMO therapy.

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“…This is achieved through dilation and constriction of cerebral blood vessels in response to fluctuations in mean arterial pressure. This is a complex process mediated through neurogenic regulation, involving sympathetic and cholinergic mechanisms, myogenic regulation involving smooth muscle tone, and metabolic regulation influenced by local concentration of metabolites [12]. Cerebral autoregulation can become disrupted focally or globally in pathological conditions leading to cerebral ischemia, hemorrhage or edema.…”

Section: Cerebral Blood Flow and Oxygenation On Ecmomentioning

confidence: 99%

“…Occlusion of vessels can cause ipsilateral venous stasis and this venous congestion can lead to venous hypertension and decreased cerebral perfusion. Changes in cerebral blood flow rate and volume can contribute to altered cerebral oxygenation as demonstrated by cerebral oximetry [12]. Impairments in cerebral autoregulation, based on wavelet transform coherence, are associated with findings on neuroimaging and neurologic outcomes [16].…”

Section: Cerebral Blood Flow and Oxygenation On Ecmomentioning

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 Pathophysiology in Extracorporeal Membrane Oxygenation: Pitfalls in Daily Clinical Management

Cited by 40 publications

References 132 publications

Neurocognitive Outcome After Treatment With(out) ECMO for Neonatal Critical Respiratory or Cardiac Failure

Neurocognitive Outcome After Treatment With(out) ECMO for Neonatal Critical Respiratory or Cardiac Failure

Longtime Neurologic Outcome of Extracorporeal Membrane Oxygenation and Non Extracorporeal Membrane Oxygenation Acute Respiratory Distress Syndrome Survivors

Neurologic Complications and Neuromonitoring on ECMO

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