Neurological Prognostication Using Electroencephalogram in Adult Veno-arterial Extracorporeal Membrane Oxygenation: Limitations and Recommendations

Cho, Sung Min; Ritzl, Eva K.

doi:10.1007/s12028-020-01099-8

Cited by 7 publications

(4 citation statements)

References 12 publications

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“…This intricate procedure demands procedural expertise, teamwork, and meticulous monitoring to ensure optimal blood flow and prevent complications. ECPR is integrated within a continuum of care, encompassing postresuscitation management, cardiac catheterization to address underlying causes, targeted temperature management to mitigate brain injury, 55 and ongoing monitoring of cardiac function 56 and neurological status 57,58 . The collaborative efforts of healthcare professionals from various disciplines are fundamental to this system, allowing for swift and strategic decision‐making throughout each stage of care, ultimately increasing the potential for improved patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

The state of emergency department extracorporeal cardiopulmonary resuscitation: Where are we now, and where are we going?

Ciullo,

Tonna

2024

JACEP Open

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Extracorporeal cardiopulmonary resuscitation (ECPR) has emerged in the context of the emergency department as a life‐saving therapy for patients with refractory cardiac arrest. This review examines the utility of ECPR based on current evidence gleaned from three pivotal trials: the ARREST trial, the Prague study, and the INCEPTION trial. We also discuss several considerations in the care of these complex patients, including prehospital strategy, patient selection, and postcardiac arrest management. Collectively, the evidence from these trials emphasizes the growing significance of ECPR as a viable intervention, highlighting its potential for improved outcomes and survival rates in patients with refractory cardiac arrest when employed judiciously. As such, these findings advocate the need for further research and protocol development to optimize its use in diverse clinical scenarios.

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Section: Discussionmentioning

confidence: 99%

The state of emergency department extracorporeal cardiopulmonary resuscitation: Where are we now, and where are we going?

Ciullo,

Tonna

2024

JACEP Open

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“…Even if head computed tomography (HCT) is performed, the utility of HCT in detecting early ischemia and lesions in the posterior circulation territory is limited. Other noninvasive neurological monitoring methods include TCD, somatosensory evoked potentials, cerebral near-infrared spectroscopy (cNIRS), and electroencephalography (EEG), which may systematically assess the occurrence of ABI [103][104][105]. Another useful tool for noninvasive monitoring is optic nerve sheath diameter measurement with ultrasound, which may provide information on intracranial pressure [102].…”

Section: Neurologic Monitoring For Abi In Ecprmentioning

confidence: 99%

“…Furthermore, EEG features such as absent EEG reactivity and discontinuous background may be associated with poor outcomes in comatose ECMO patients [109,110]. Therefore, cEEG monitoring is recommended for ECMO patients with disorders of consciousness off sedation and somatosensory evoked potentials for patients with motor Glasgow Coma Scale scores of < 4 [103,104]. Optic nerve sheath diameter can be abnormal due to ABI but is less useful in the prevention of injury [111].…”

Section: Neurologic Monitoring For Abi In Ecprmentioning

confidence: 99%

Brain injury in extracorporeal cardiopulmonary resuscitation: translational to clinical research

2021

Self Cite

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The addition of extracorporeal membrane oxygenation (ECMO) to conventional cardiopulmonary resuscitation (CPR), termed extracorporeal cardiopulmonary resuscitation (ECPR), has significantly improved survival in selected patient populations. Despite this advancement, significant neurological impairment persists in approximately half of survivors. ECPR represents a potential advancement for patients who experience refractory cardiac arrest (CA) due to a reversible etiology and do not regain spontaneous circulation. Important risk factors for acute brain injury (ABI) in ECPR include lack of perfusion, reperfusion, and altered cerebral autoregulation. The initial hypoxic-ischemic injury caused by no-flow and low-flow states after CA and during CPR is compounded by reperfusion, hyperoxia during ECMO support, and nonpulsatile blood flow. Additionally, ECPR patients are at risk for Harlequin syndrome with peripheral cannulation, which can lead to preferential perfusion of cerebral vessels with deoxygenated blood. Lastly, the oxygenator membrane is prothrombotic and requires systemic anticoagulation. The two competing phenomena result in thrombus formation, hemolysis, and thrombocytopenia, increasing the risk of ischemic and hemorrhagic ABI. In addition to clinical studies, we assessed available ECPR animal models to identify the mechanisms underlying ABI at the cellular level. Standardized multimodal neurological monitoring may facilitate early detection of and intervention for ABI. With the increasing use of ECPR, it is critical to understand the pathophysiology of ABI, its prevention, and the management strategies for improving the outcomes of ECPR. Translational and clinical research focusing on acute ABI immediately after ECMO cannulation and its short-and long-term neurological outcomes are warranted.

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“…The consultation is often challenging because the patient is in a coma, and it is not clear if a neurologic insult has occurred, and imaging is unavailable or unrevealing. The assessment is typically further complicated by the presence of sedative-hypnotic medication, which blunts the neurologic examination and affects neurophysiologic monitoring, such as EEG [ 7 ]. The assessment is often crucial to overall goals of care decision-making and may have profound implications for the patient and society.…”

mentioning

confidence: 99%

Dynamic Variables of Electroencephalography may be a Window into Brain Responsiveness

Vespa

2022

Neurocrit Care

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Neurological Prognostication Using Electroencephalogram in Adult Veno-arterial Extracorporeal Membrane Oxygenation: Limitations and Recommendations

Cited by 7 publications

References 12 publications

The state of emergency department extracorporeal cardiopulmonary resuscitation: Where are we now, and where are we going?

The state of emergency department extracorporeal cardiopulmonary resuscitation: Where are we now, and where are we going?

Brain injury in extracorporeal cardiopulmonary resuscitation: translational to clinical research

Dynamic Variables of Electroencephalography may be a Window into Brain Responsiveness

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