Early Electroencephalography Findings in Cardiogenic Shock Patients Treated by Venoarterial Extracorporeal Membrane Oxygenation

Sinnah, Fabrice; Dalloz, Marie-Amélie; Magalhaes, Eric; Wanono, Ruben; Neuville, Mathilde; Smonig, Roland; Radjou, Aguila; Mourvillier, Bruno; Bouadma, Lila; Timsit, Jean‐François; d’Ortho, Marie-Pia; Rouvel-Tallec, Any; Sonneville, Romain

doi:10.1097/ccm.0000000000003010

Cited by 27 publications

(17 citation statements)

References 31 publications

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“…In one study, 2 of the 13 adult patients had seizures and required specific antiepileptic medications; all EEGs had a background of predominant theta and delta frequencies and severe encephalopathy (i.e., poor variability and absence of reactivity) was associated with unfavorable neurologic outcome [ 8 ]. In another study including 25 adult patients on V-A ECMO, 95% of patients had a diffuse EEG slowing and 59% had discontinuous or an unreactive background; more severe findings were more frequently observed in patients with poor neurological outcome [ 14 ]. In a larger prospective cohort of V–A ECMO patients, low background frequency and an unreactive EEG were independently associated with poor outcome at 28 days [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…In critically ill patients, EEG is widely used to recognize or assess different neurological complications, such as seizure and encephalopathy [ 10 , 11 ], or to prognosticate neurological outcome after an acute brain injury [ 12 , 13 ]. Nevertheless, the use of EEG as neuromonitoring tool in adult ECMO patients has also been reported only in small case-series [ 8 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Electroencephalographic features in patients undergoing extracorporeal membrane oxygenation

et al. 2020

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Background Neurologic injury is one of the most frequent causes of death in patients undergoing extracorporeal membrane oxygenation (ECMO). As neurological examination is often unreliable in sedated patients, additional neuromonitoring is needed. However, the value of electroencephalogram (EEG) in adult ECMO patients has not been well assessed. Therefore, the aim of this study was to assess the occurrence of electroencephalographic abnormalities in patients treated with extracorporeal membrane oxygenation (ECMO) and their association with 3-month neurologic outcome. Methods Retrospective analysis of all patients undergoing venous–venous (V–V) or venous–arterial (V–A) ECMO with a concomitant EEG recording (April 2009–December 2018), either recorded intermittently or continuously. EEG background was classified into four categories: mild/moderate encephalopathy (i.e., mostly defined by the presence of reactivity), severe encephalopathy (mostly defined by the absence of reactivity), burst-suppression (BS) and suppressed background. Epileptiform activity (i.e., ictal EEG pattern, sporadic epileptiform discharges or periodic discharges) and asymmetry were also reported. EEG findings were analyzed according to unfavorable neurological outcome (UO, defined as Glasgow Outcome Scale < 4) at 3 months after discharge. Results A total of 139 patients (54 [41–62] years; 60 (43%) male gender) out of 596 met the inclusion criteria and were analyzed. Veno–arterial (V–A) ECMO was used in 98 (71%); UO occurred in 99 (71%) patients. Continuous EEG was performed in 113 (81%) patients. The analysis of EEG background showed that 29 (21%) patients had severe encephalopathy, 4 (3%) had BS and 19 (14%) a suppressed background. In addition, 11 (8%) of patients had seizures or status epilepticus, 10 (7%) had generalized periodic discharges or lateralized periodic discharges, and 27 (19%) had asymmetry on EEG. In the multivariate analysis, the occurrence of ischemic stroke or intracranial hemorrhage (OR 4.57 [1.25–16.74]; p = 0.02) and a suppressed background (OR 10.08 [1.24–82.20]; p = 0.03) were independently associated with UO. After an adjustment for covariates, an increasing probability for UO was observed with more severe EEG background categories. Conclusions In adult patients treated with ECMO, EEG can identify patients with a high likelihood of poor outcome. In particular, suppressed background was independently associated with unfavorable neurological outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Electroencephalographic features in patients undergoing extracorporeal membrane oxygenation

et al. 2020

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“…Intracranial bleeding but not ischemic strokes were associated with higher mortality (39). Early severe background abnormalities and the lack of sleep transients on standard and continuous electroencephalography were associated with poor neurological outcome of VA-ECMO patients, suggesting the value of electroencephalography in predicting the neurological outcome in such patients (40). 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.…”

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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“…However, the study did not standardize the timing for initiating EEG monitoring in all their patients. Two studies confirmed that background abnormalities on standard EEG at the early phase (1–3 d) were highly predictive of brain injury and poor outcome in patients on VA ECMO ( 54 , 55 ). Furthermore, the authors also found that a lack of sleep transients on continuous EEG reflects the severity of brain dysfunction and might serve as an additional prognostic marker.…”

Section: Clinical Strategiesmentioning

confidence: 84%

Narrative Review of Neurologic Complications in Adults on ECMO: Prevalence, Risks, Outcomes, and Prevention Strategies

Zhang

Yang

et al. 2021

Front. Med.

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Extracorporeal membrane oxygenation (ECMO), a life-saving technique for patients with severe respiratory and cardiac diseases, is being increasingly utilized worldwide, particularly during the coronavirus disease 2019(COVID-19) pandemic, and there has been a sharp increase in the implementation of ECMO. However, due to the presence of various complications, the survival rate of patients undergoing ECMO remains low. Among the complications, the neurologic morbidity significantly associated with venoarterial and venovenous ECMO has received increasing attention. Generally, failure to recognize neurologic injury in time is reportedly associated with poor outcomes in patients on ECMO. Currently, multimodal monitoring is increasingly utilized in patients with devastating neurologic injuries and has been advocated as an important approach for early diagnosis. Here, we highlight the prevalence and outcomes, risk factors, current monitoring technologies, prevention, and treatment of neurologic complications in adult patients on ECMO. We believe that an improved understanding of neurologic complications presumably offers promising therapeutic solutions to prevent and treat neurologic morbidity.

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Early Electroencephalography Findings in Cardiogenic Shock Patients Treated by Venoarterial Extracorporeal Membrane Oxygenation

Cited by 27 publications

References 31 publications

Electroencephalographic features in patients undergoing extracorporeal membrane oxygenation

Electroencephalographic features in patients undergoing extracorporeal membrane oxygenation

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

Narrative Review of Neurologic Complications in Adults on ECMO: Prevalence, Risks, Outcomes, and Prevention Strategies

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