Neurologic Complications and Neuromonitoring on ECMO

Abstract

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.

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

“…18 Focal cerebral ischemia may be just as detrimental as global cerebral ischemia in terms of VA-ECMO outcomes, disability, and disruption of cerebral autoregulation. 20 rSO 2 asymmetry should be interpreted carefully, as we found that short episodes of rSO 2 asymmetry observed on the time scale of a few hours are not associated with ABI, but when a patient on average exhibits >8% rSO 2 asymmetry over the entire duration of cNIRS monitoring, the odds of ABI are significantly increased compared to those without asymmetry, which likely represents an ongoing ABI. A failure to recognize and address the presence of ABI in a timely manner can result in poor outcomes.…”

Peripheral neuropathy after extra-corporeal membrane oxygenation therapy in children

“…[15][16][17] It seems likely that these are due to a more stable hemodynamic transition than arterial assessment and the low risk of embolization due to the filtering of thrombi by blood returning to the venous system in VV-ECMO. [3,13] Additionally, due to the close anatomical proximity of the various important structures and the narrow vascular diameter in the pediatric population, ultrasound-guided procedures are recommended for invasive intervention (vascular access and regional anesthetic technique) in children for anatomical assessment and accurate needle insertion. [18][19][20] Image-guided ECMO intervention with real-time ultrasound or fluoroscopy has to be suggested in neonatal intensive care unit and pediatric intensive care unit patients to decrease neurologic injury.…”

“…As neuralgic complications have a significant impact on the survival and quality of life in ECMO-treated children, early detection of peripheral neural injury and preventive strategies are required. There are several guidelines for neuromonitoring of the central nervous system, including neuroimaging (cranial ultrasound, CT, and MRI), electroencephalography, transcranial Doppler ultrasound, cerebral near-infrared spectroscopy, biomarkers (S100β, GFAP, neuron-specific enolase, and IL-6), somatosensory evoked potentials, and optic nerve sheath diameter [3] . However, peripheral nerve injury has rarely been reported in previous cases, and there are no recommendations for neuromonitoring of the peripheral nervous system.…”

“…They suggested that VV-ECMO has been favored over VA-ECMO in the pediatric population, except in several indications where VA-ECMO is preferred, such as inadequate cardiac function and lung transplantation bridge-ECMO [15–17] . It seems likely that these are due to a more stable hemodynamic transition than arterial assessment and the low risk of embolization due to the filtering of thrombi by blood returning to the venous system in VV-ECMO [3,13] . Additionally, due to the close anatomical proximity of the various important structures and the narrow vascular diameter in the pediatric population, ultrasound-guided procedures are recommended for invasive intervention (vascular access and regional anesthetic technique) in children for anatomical assessment and accurate needle insertion [18–20] .…”

“…Extra-corporeal membrane oxygenation (ECMO) has remarkably progressed over the recent years and has become a therapeutic option in adults and children with cardiorespiratory failure [1,2] . Neurological complications after ECMO occur frequently, with the prevalence and types of neurologic complications varying according to patient population [3] . Based on data from the National Extracorporeal Life Support Organization (ELSO) Registry, neurological complications have been reported in 7.1% of ECMO-treated adults, with intracranial hemorrhage being the most common, followed by acute ischemic stroke in adults [4,5] .…”