PDF(Pubmed)
Abstract：
UNASSIGNED: Extracorporeal membrane oxygenation (ECMO) carries a high morbidity of acute brain injury (ABI) with resultant mortality increase. Transcranial Doppler (TCD) allows real-time characterization of regional cerebral hemodynamics, but limited data exist on the interpretation of microembolic signals (MES) in ECMO.
UNASSIGNED: This prospective cohort study was conducted at a single tertiary care center, November 2017 through February 2022, and included all adult patients receiving venoarterial (VA) and venovenous (VV) ECMO undergoing TCD examinations, which all included MES monitoring.
UNASSIGNED: Of 145 patients on ECMO who underwent at least 1 TCD examination, 100 (68.9%) patients on VA-ECMO received 187 examinations whereas 45 (31.1%) patients on VV-ECMO received 65 examinations (P = .81). MES were observed in 35 (35.0%) patients on VA-ECMO and 2 (4.7%) patients on VV-ECMO (P < .001), corresponding to 46 (24.6%) and 2 (3.1%) TCD examinations, respectively. MES were present in 29.4% of patients on VA-ECMO without additional cardiac support, compared with 38.1% with intra-aortic balloon pump and 57.1% with left ventricular assist device, but these differences were not statistically significant (P = .39; P = .20, respectively). Presence or number of MES was not associated with VA-ECMO cannulation mode (23.4% MES presence in peripheral cannulation vs 25.8% in central cannulation, P = .80). In both VA- and VV-ECMO, MES presence or number was not associated with presence of clot or fibrin in the ECMO circuit or with any studied hemodynamic, laboratory, or ECMO parameters at the time of TCD. ABI occurred in 38% and 31.1% of patients on VA- and VV-ECMO, respectively. In multivariable logistic regression analyses, neither ABI nor a composite outcome of arterial thromboembolic events was associated with presence or number of MES in VA- ECMO.
UNASSIGNED: TCD analysis in a large cohort of patients on ECMO demonstrates a significant number of MES, especially in patients on VA-ECMO with intra-aortic balloon pump, and/or left ventricular assist device. However, clinical associations and significance of TCD MES remain unresolved and warrant further correlation with systematic imaging and long-term neurologic follow-up.
UNASSIGNED: This prospective cohort study was conducted at a single tertiary care center, November 2017 through February 2022, and included all adult patients receiving venoarterial (VA) and venovenous (VV) ECMO undergoing TCD examinations, which all included MES monitoring.
UNASSIGNED: Of 145 patients on ECMO who underwent at least 1 TCD examination, 100 (68.9%) patients on VA-ECMO received 187 examinations whereas 45 (31.1%) patients on VV-ECMO received 65 examinations (P = .81). MES were observed in 35 (35.0%) patients on VA-ECMO and 2 (4.7%) patients on VV-ECMO (P < .001), corresponding to 46 (24.6%) and 2 (3.1%) TCD examinations, respectively. MES were present in 29.4% of patients on VA-ECMO without additional cardiac support, compared with 38.1% with intra-aortic balloon pump and 57.1% with left ventricular assist device, but these differences were not statistically significant (P = .39; P = .20, respectively). Presence or number of MES was not associated with VA-ECMO cannulation mode (23.4% MES presence in peripheral cannulation vs 25.8% in central cannulation, P = .80). In both VA- and VV-ECMO, MES presence or number was not associated with presence of clot or fibrin in the ECMO circuit or with any studied hemodynamic, laboratory, or ECMO parameters at the time of TCD. ABI occurred in 38% and 31.1% of patients on VA- and VV-ECMO, respectively. In multivariable logistic regression analyses, neither ABI nor a composite outcome of arterial thromboembolic events was associated with presence or number of MES in VA- ECMO.
UNASSIGNED: TCD analysis in a large cohort of patients on ECMO demonstrates a significant number of MES, especially in patients on VA-ECMO with intra-aortic balloon pump, and/or left ventricular assist device. However, clinical associations and significance of TCD MES remain unresolved and warrant further correlation with systematic imaging and long-term neurologic follow-up.
摘要：
未经证实：体外膜氧合（ECMO）具有较高的急性脑损伤（ABI）发病率，导致死亡率增加。经颅多普勒（TCD）可以实时表征局部脑血流动力学，但ECMO中微栓子信号(MES)的解释数据有限.
UNASSIGNED：这项前瞻性队列研究是在一家三级护理中心进行的，2017年11月至2022年2月，包括所有接受静脉动脉（VA）和静脉静脉（VV）ECMO接受TCD检查的成年患者，其中包括MES监控。
未经证实：145名接受ECMO至少1次TCD检查的患者，接受VA-ECMO的100例（68.9％）患者接受了187次检查，而接受VV-ECMO的45例（31.1％）患者接受了65次检查（P=0.81）。35例（35.0%）患者接受VA-ECMO，2例（4.7%）患者接受VV-ECMO（P<.001），对应于46次(24.6%)和2次(3.1%)TCD检查，分别。29.4%的VA-ECMO患者没有额外的心脏支持，与主动脉内球囊泵的38.1%和左心室辅助装置的57.1%相比，但这些差异没有统计学意义（分别为P=0.39;P=0.20）。MES的存在或数量与VA-ECMO插管模式无关(外周插管中23.4%MES的存在与中央插管中25.8%的存在,P=.80）。在VA-和VV-ECMO中，MES的存在或数量与ECMO回路中的凝块或纤维蛋白的存在或任何研究的血液动力学无关，实验室,或TCD时的ECMO参数。在接受VA和VV-ECMO的患者中，ABI发生率分别为38％和31.1％，分别。在多变量逻辑回归分析中，ABI和动脉血栓栓塞事件的复合结局均与VA-ECMO中MES的存在或数量无关.
未经证实：在接受ECMO治疗的一大群患者中进行的TCD分析显示，有相当数量的MES，尤其是在使用主动脉内球囊反搏的VA-ECMO患者中，和/或左心室辅助装置。然而,TCDMES的临床相关性和意义仍未解决,需要进一步与系统成像和长期神经系统随访相关.
UNASSIGNED：这项前瞻性队列研究是在一家三级护理中心进行的，2017年11月至2022年2月，包括所有接受静脉动脉（VA）和静脉静脉（VV）ECMO接受TCD检查的成年患者，其中包括MES监控。
未经证实：145名接受ECMO至少1次TCD检查的患者，接受VA-ECMO的100例（68.9％）患者接受了187次检查，而接受VV-ECMO的45例（31.1％）患者接受了65次检查（P=0.81）。35例（35.0%）患者接受VA-ECMO，2例（4.7%）患者接受VV-ECMO（P<.001），对应于46次(24.6%)和2次(3.1%)TCD检查，分别。29.4%的VA-ECMO患者没有额外的心脏支持，与主动脉内球囊泵的38.1%和左心室辅助装置的57.1%相比，但这些差异没有统计学意义（分别为P=0.39;P=0.20）。MES的存在或数量与VA-ECMO插管模式无关(外周插管中23.4%MES的存在与中央插管中25.8%的存在,P=.80）。在VA-和VV-ECMO中，MES的存在或数量与ECMO回路中的凝块或纤维蛋白的存在或任何研究的血液动力学无关，实验室,或TCD时的ECMO参数。在接受VA和VV-ECMO的患者中，ABI发生率分别为38％和31.1％，分别。在多变量逻辑回归分析中，ABI和动脉血栓栓塞事件的复合结局均与VA-ECMO中MES的存在或数量无关.
未经证实：在接受ECMO治疗的一大群患者中进行的TCD分析显示，有相当数量的MES，尤其是在使用主动脉内球囊反搏的VA-ECMO患者中，和/或左心室辅助装置。然而,TCDMES的临床相关性和意义仍未解决,需要进一步与系统成像和长期神经系统随访相关.
