Neurological Pupil index for Early Prognostication After Venoarterial Extracorporeal Membrane Oxygenation

Miroz, John‐Paul; Ben-Hamouda, Nawfel; Bernini, Adriano; Romagnosi, Federico; Bongiovanni, Filippo; Roumy, Aurélien; Kirsch, Matthias; Liaudet, Lucas; Eckert, Philippe; Oddo, Mauro

doi:10.1016/j.chest.2019.11.037

Cited by 42 publications

(33 citation statements)

References 46 publications

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“…During this period, our internal recommendations for starting ECPR were: refractory OHCA or IHCA; no flow < 5 min; low flow < 80 min; age < 75 years; absence of major co-morbidities; absence of Do Not Resuscitate order. A subset of patients of the current cohort were also included in an unrelated study evaluating automated pupillometry during Veno-Arterial ECMO (VA-ECMO) for various indications [ 15 ].…”

Section: Methodsmentioning

confidence: 99%

Hyperoxia during extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest is associated with severe circulatory failure and increased mortality

Bonnemain

Ltaief

Roumy

et al. 2021

BMC Cardiovasc Disord

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Background High levels of arterial oxygen pressures (PaO2) have been associated with increased mortality in extracorporeal cardiopulmonary resuscitation (ECPR), but there is limited information regarding possible mechanisms linking hyperoxia and death in this setting, notably with respect to its hemodynamic consequences. We aimed therefore at evaluating a possible association between PaO2, circulatory failure and death during ECPR. Methods We retrospectively analyzed 44 consecutive cardiac arrest (CA) patients treated with ECPR to determine the association between the mean PaO2 over the first 24 h, arterial blood pressure, vasopressor and intravenous fluid therapies, mortality, and cause of deaths. Results Eleven patients (25%) survived to hospital discharge. The main causes of death were refractory circulatory shock (46%) and neurological damage (24%). Compared to survivors, non survivors had significantly higher mean 24 h PaO2 (306 ± 121 mmHg vs 164 ± 53 mmHg, p < 0.001), lower mean blood pressure and higher requirements in vasopressors and fluids, but displayed similar pulse pressure during the first 24 h (an index of native cardiac recovery). The mean 24 h PaO2 was significantly and positively correlated with the severity of hypotension and the intensity of vasoactive therapies. Patients dying from circulatory failure died after a median of 17 h, compared to a median of 58 h for patients dying from a neurological cause. Patients dying from neurological cause had better preserved blood pressure and lower vasopressor requirements. Conclusion In conclusion, hyperoxia is associated with increased mortality during ECPR, possibly by promoting circulatory collapse or delayed neurological damage.

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Section: Methodsmentioning

confidence: 99%

Hyperoxia during extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest is associated with severe circulatory failure and increased mortality

Bonnemain

Ltaief

Roumy

et al. 2021

BMC Cardiovasc Disord

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“…In addition, the NPi might be a useful parameter for estimating the severity of aneurysmal subarachnoid hemorrhage, in which reduced NPi values are associated with poor clinical outcomes ( 38 ). Recently, a single-center study showed that an abnormal NPi <3 from 24 to 72 h following VA ECMO insertion had 100% specificity and 53% sensitivity in predicting 90-day mortality ( 39 ). However, several aspects should be considered when the NPi is applied.…”

Section: Clinical Strategiesmentioning

confidence: 99%

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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“…During this period, our internal recommendations for starting ECPR were: refractory OHCA or IHCA; no ow < 5min; low ow < 80 min; age < 75y; absence of major co-morbidities; absence of Do Not Resuscitate order. A subset of patients of the current cohort were also included in an unrelated study evaluating automated pupillometry during Veno-Arterial ECMO (VA-ECMO) for various indications (15).…”

Section: Study Settingmentioning

confidence: 99%

Hyperoxia During Extracorporeal Cardiopulmonary Resuscitation for Refractory Cardiac Arrest Is Associated With Severe Circulatory Failure and Increased Mortality

Bonnemain

Ltaief

Roumy

et al. 2021

Preprint

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Background: High levels of arterial oxygen pressures (PaO2) have been associated with increased mortality in extracorporeal cardiopulmonary resuscitation (ECPR), but there is limited information regarding possible mechanisms linking hyperoxia and death in this setting, notably with respect to its hemodynamic consequences. We aimed therefore at evaluating a possible association between PaO2, circulatory failure and death during ECPR.Methods: We retrospectively analyzed 44 consecutive cardiac arrest (CA) patients treated with ECPR to determine the association between the mean PaO2 over the first 24h, arterial blood pressure, vasopressor and intravenous fluid therapies, mortality, and cause of deaths.Results: Eleven patients (25%) survived to hospital discharge. The main causes of death were refractory circulatory shock (46%) and neurological damage (24%). Compared to survivors, non survivors had significantly higher mean 24h PaO2 (306±121 mmHg vs 164±53 mmHg, p < 0.001), lower mean blood pressure and higher requirements in vasopressors and fluids, but displayed similar pulse pressure during the first 24h (an index of native cardiac recovery). The mean 24h PaO2 was significantly correlated with hypotension and vasoactive therapies. Patients dying from neurological cause had better preserved blood pressure and lower vasopressor requirements. Patients dying from circulatory failure died after a median of 17h, compared to a median of 58 h for patients dying from a neurological cause (OR 0.95, 95% CI 0.90–0.99, p = 0.001).Conclusion: In conclusion, hyperoxia is associated with increased mortality during ECPR, possibly by promoting circulatory collapse or delayed neurological damage.

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Neurological Pupil index for Early Prognostication After Venoarterial Extracorporeal Membrane Oxygenation

Cited by 42 publications

References 46 publications

Hyperoxia during extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest is associated with severe circulatory failure and increased mortality

Hyperoxia during extracorporeal cardiopulmonary resuscitation for refractory cardiac arrest is associated with severe circulatory failure and increased mortality

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

Hyperoxia During Extracorporeal Cardiopulmonary Resuscitation for Refractory Cardiac Arrest Is Associated With Severe Circulatory Failure and Increased Mortality

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