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

Zhang, Hongling; Xu, Jiqian; Yang, Xiaobo; Zou, Xiaojing; Shu, Huaqing; Liu, Zhengdong; Shang, You

doi:10.3389/fmed.2021.713333

Cited by 16 publications

(8 citation statements)

References 86 publications

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“…ECMO can save the lives of burn patients, but it carries a high risk, and its adverse results may be caused by brain injury. [ 12 , 13 ] Indeed, nerve injury increased dramatically in ECMO patients. Studies have demonstrated that 15% to 35% of ECMO patients developed neurological damage.…”

Section: Literature Review and Discussionmentioning

confidence: 99%

Use of extracorporeal membrane oxygenation in children with burn injury: Case report and literature review

et al. 2023

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Rationale: Burns are one of the most debilitating injuries in the world and one of the major causes of accidental disability and death among children. Severe burns can result in irreversible brain damage, placing patients at high risk of brain failure and high mortality. Therefore, timely diagnosis and treatment of burn encephalopathy are crucial for improving prognosis. In recent years, extracorporeal membrane oxygenation (ECMO) has been increasingly used to improve the prognosis of patients with burns. Here, we report a case of ECMO treatment in a child with burns and review the relevant literature.Patient concerns: A 7-year-old boy with a modified Baux score of 24 presented with asphyxia, loss of consciousness, refractory hypoxemia, and malignant arrhythmia after smoke inhalation for 1 day. Fiberoptic bronchoscopy revealed a large amount of black carbon-like substances aspirated from the trachea.Diagnoses: Considering that the boy inhaled a large amount of smoke, the clinical manifestation was unclear consciousness, laboratory examination revealed continuous low blood oxygen saturation, and bronchoscopy revealed a large amount of black carbon-like substances in the trachea, thereby leading to the diagnosis of asphyxia, inhalation pneumonia, burn encephalopathy, multiple organ dysfunction syndrome, and malignant arrhythmia. In addition, pulmonary edema and carbon monoxide poisoning are caused by chemical agents, gas fumes, and vapors.Interventions: The boy's blood oxygen saturation and blood circulation remained unstable despite various ventilation methods and medications, thus we decided to use ECMO. After 8 days of ECMO support, the patient was successfully weaned from the machine.Outcomes: Under the application of ECMO, the respiratory and circulatory systems significantly improved. Nevertheless, due to the progressive brain injury caused by burns and the poor prognosis, the parents ceased all treatment and the boy passed away.Lessons: This case report demonstrates that brain edema and herniation can arise as phenotypes of burn encephalopathy, which is a challenge to treat in children. Children with confirmed or suspected burn encephalopathy should undergo diagnostic tests completed as soon as possible to confirm the diagnosis. After receiving ECMO treatment, the respiratory and circulatory systems of the burn victims reported significantly improved. Hence, ECMO is a viable alternative for supporting patients with burns.

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Section: Literature Review and Discussionmentioning

confidence: 99%

Use of extracorporeal membrane oxygenation in children with burn injury: Case report and literature review

et al. 2023

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“…A failure to recognize and address the presence of ABI in a timely manner can result in poor outcomes. 21,22 The presence of significant rSO 2 asymmetry can help clinicians with early detection of ABIs and intervention for ongoing ABIs.…”

Section: Discussionmentioning

confidence: 99%

Trends on Near-Infrared Spectroscopy Associated With Acute Brain Injury in Venoarterial Extracorporeal Membrane Oxygenation

Zhao,

Shou,

Caturegli

et al. 2023

ASAIO Journal

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We aimed to determine the association between cerebral regional oxygen saturation (rSO2) trends from cerebral near-infrared spectroscopy (cNIRS) and acute brain injury (ABI) in adult venoarterial extracorporeal membrane oxygenation (VA-ECMO) patients. ABI was defined as intracranial hemorrhage, ischemic stroke, hypoxic ischemic brain injury, or brain death during ECMO. rSO2 values were collected from left and right cerebral oximetry sensors every hour from ECMO cannulation. Cerebral desaturation was defined as consecutive hours of rSO2 < 40%. rSO2 asymmetry was determined by (a) averaging left/right rSO2 difference over the entire ECMO run; (b) consecutive hours of rSO2 asymmetry. Sixty-nine VA-ECMO patients (mean age 56 years, 65% male) underwent cNIRS. Eighteen (26%) experienced ABI. When the mean rSO2 asymmetry was >8% there was significantly increased odds of ABI (aOR = 39.4; 95% CI = 4.1–381.4). Concurrent rSO2 < 40% and rSO2 asymmetry >10% for >10 consecutive hours (asymmetric desaturation) was also significantly associated with ABI (aOR = 5.2; 95% CI = 1.2–22.2), but neither criterion alone were. Mean rSO2 asymmetry>8% exhibited 39% sensitivity and 98% specificity for detecting ABI, with an area under the curve (AUC) of 0.86, and asymmetric desaturation had 33% sensitivity and 88% specificity, with an AUC of 0.72. These trends on NIRS monitoring may help detect ABI in VA-ECMO patients.

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“…Incidence of ICH and acute ischemic stroke range from 3.6%-16.4% and 1.7%-7%, respectively. 28 The literature suggests that most neurologic complications may arise within 6 h of ECMO initiation. 28 A study demonstrated a 31.7% mortality rate in those with ICH, they reported no significant difference in 6-month survival for patients with and without ICH, and the majority (92%) made a good neurologic recovery.…”

Section: Discussionmentioning

confidence: 99%

“…28 The literature suggests that most neurologic complications may arise within 6 h of ECMO initiation. 28 A study demonstrated a 31.7% mortality rate in those with ICH, they reported no significant difference in 6-month survival for patients with and without ICH, and the majority (92%) made a good neurologic recovery. 29 Notably, they report immediate cessation of anticoagulation upon detection of ICH, and they posit that this strategy may drastically decrease their mortality rate compared to previous studies.…”

Section: Discussionmentioning

confidence: 99%

Utilization and Outcomes of Extracorporeal Membrane Oxygenation Following Traumatic Brain Injury in the United States

Hatfield

Ohnuma

Soto

et al. 2022

J Intensive Care Med

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Objectives: Describe contemporary ECMO utilization patterns among patients with traumatic brain injury (TBI) and examine clinical outcomes among TBI patients requiring ECMO. Design: Retrospective cohort study. Setting: Premier Healthcare Database (PHD) between January 2016 to June 2020. Subjects: Adult patients with TBI who were mechanically ventilated and stratified by exposure to ECMO. Results: Among patients exposed to ECMO, we examined the following clinical outcomes: hospital LOS, ICU LOS, duration of mechanical ventilation, and hospital mortality. Of our initial cohort (n = 59,612), 118 patients (0.2%) were placed on ECMO during hospitalization. Most patients were placed on ECMO within the first 2 days of admission (54.3%). Factors associated with ECMO utilization included younger age (OR 0.96, 95% CI (0.95–0.97)), higher injury severity score (ISS) (OR 1.03, 95% CI (1.01–1.04)), vasopressor utilization (2.92, 95% CI (1.90–4.48)), tranexamic acid utilization (OR 1.84, 95% CI (1.12–3.04)), baseline comorbidities (OR 1.06, 95% CI (1.03–1.09)), and care in a teaching hospital (OR 3.04, 95% CI 1.31–7.05). A moderate degree (ICC = 19.5%) of variation in ECMO use was explained at the individual hospital level. Patients exposed to ECMO had longer median (IQR) hospital and ICU length of stay (LOS) [26 days (11–36) versus 9 days (4–8) and 19.5 days (8–32) versus 5 days (2–11), respectively] and a longer median (IQR) duration of mechanical ventilation [18 days (8–31) versus 3 days (2–8)]. Patients exposed to ECMO experienced a hospital mortality rate of 33.9%, compared to 21.2% of TBI patients unexposed to ECMO. Conclusions: ECMO utilization in mechanically ventilated patients with TBI is rare, with significant variation across hospitals. The impact of ECMO on healthcare utilization and hospital mortality following TBI is comparable to non-TBI conditions requiring ECMO. Further research is necessary to better understand the role of ECMO following TBI and identify patients who may benefit from this therapy.

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

Cited by 16 publications

References 86 publications

Use of extracorporeal membrane oxygenation in children with burn injury: Case report and literature review

Use of extracorporeal membrane oxygenation in children with burn injury: Case report and literature review

Trends on Near-Infrared Spectroscopy Associated With Acute Brain Injury in Venoarterial Extracorporeal Membrane Oxygenation

Utilization and Outcomes of Extracorporeal Membrane Oxygenation Following Traumatic Brain Injury in the United States

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