Abstract：
BACKGROUND: Early diagnosis of acute brain injury (ABI) is critical for patients on veno-arterial extracorporeal membrane oxygenation (V-A ECMO) to guide anticoagulation strategy; however, neurological assessment in ECMO is often limited by patient sedation.
METHODS: In this pilot study of adults from June 2018 to May 2019, plasma samples of glial fibrillary acidic protein (GFAP), neurofilament light chain (NFL), and tubulin associated unit (Tau) were collected daily after V-A ECMO cannulation and measured using a multiplex platform. Primary outcomes were occurrence of ABI, assessed clinically, and neurologic outcome, assessed by modified Rankin Scale (mRS).
RESULTS: Of 20 consented patients (median age = 48.5°years; 55% female), 8 (40%) had ABI and 15 (75%) had unfavorable neurologic outcome at discharge. 10 (50%) patients were centrally cannulated. Median duration on ECMO was 4.5°days (IQR: 2.5-9.5). Peak GFAP, NFL, and Tau levels were higher in patients with ABI vs. without (AUC = 0.77; 0.85; 0.57, respectively) and in patients with unfavorable vs. favorable neurologic outcomes (AUC = 0.64; 0.59; 0.73, respectively). GFAP elevated first, NFL elevated to the highest degree, and Tau showed limited change regardless of ABI.
CONCLUSIONS: Further studies are warranted to determine how plasma biomarkers may facilitate early detection of ABIs in V-A ECMO to assist timely clinical decision-making.
METHODS: In this pilot study of adults from June 2018 to May 2019, plasma samples of glial fibrillary acidic protein (GFAP), neurofilament light chain (NFL), and tubulin associated unit (Tau) were collected daily after V-A ECMO cannulation and measured using a multiplex platform. Primary outcomes were occurrence of ABI, assessed clinically, and neurologic outcome, assessed by modified Rankin Scale (mRS).
RESULTS: Of 20 consented patients (median age = 48.5°years; 55% female), 8 (40%) had ABI and 15 (75%) had unfavorable neurologic outcome at discharge. 10 (50%) patients were centrally cannulated. Median duration on ECMO was 4.5°days (IQR: 2.5-9.5). Peak GFAP, NFL, and Tau levels were higher in patients with ABI vs. without (AUC = 0.77; 0.85; 0.57, respectively) and in patients with unfavorable vs. favorable neurologic outcomes (AUC = 0.64; 0.59; 0.73, respectively). GFAP elevated first, NFL elevated to the highest degree, and Tau showed limited change regardless of ABI.
CONCLUSIONS: Further studies are warranted to determine how plasma biomarkers may facilitate early detection of ABIs in V-A ECMO to assist timely clinical decision-making.
摘要：
背景：急性脑损伤（ABI）的早期诊断对于静脉-动脉体外膜氧合（V-AECMO）患者的抗凝策略至关重要；然而，ECMO的神经系统评估通常受到患者镇静作用的限制.
方法：在2018年6月至2019年5月的成人初步研究中，胶质纤维酸性蛋白（GFAP）的血浆样本，神经丝轻链(NFL),在V-AECMO插管后，每天收集微管蛋白相关单位（Tau），并使用多重平台进行测量。主要结果是ABI的发生，临床评估，和神经结果，通过改良的Rankin量表(MRS)评估。
结果：在20名同意的患者中（中位年龄=48.5°岁；55％为女性），8例（40％）有ABI，15例（75％）在出院时出现不利的神经系统结局。10例（50％）患者进行了中央插管。ECMO的中位持续时间为4.5°天(IQR:2.5-9.5)。峰值GFAP,NFL,ABI患者的Tau水平高于无（AUC=0.77;0.85;0.57，分别）和不良患者有利的神经系统结果（AUC=0.64;0.59;0.73，分别）。GFAP首先升高，NFL提升到最高程度，无论ABI如何，Tau的变化都有限。
结论：需要进一步的研究来确定血浆生物标志物如何促进V-AECMO中ABIs的早期检测，以帮助及时做出临床决策。
方法：在2018年6月至2019年5月的成人初步研究中，胶质纤维酸性蛋白（GFAP）的血浆样本，神经丝轻链(NFL),在V-AECMO插管后，每天收集微管蛋白相关单位（Tau），并使用多重平台进行测量。主要结果是ABI的发生，临床评估，和神经结果，通过改良的Rankin量表(MRS)评估。
结果：在20名同意的患者中（中位年龄=48.5°岁；55％为女性），8例（40％）有ABI，15例（75％）在出院时出现不利的神经系统结局。10例（50％）患者进行了中央插管。ECMO的中位持续时间为4.5°天(IQR:2.5-9.5)。峰值GFAP,NFL,ABI患者的Tau水平高于无（AUC=0.77;0.85;0.57，分别）和不良患者有利的神经系统结果（AUC=0.64;0.59;0.73，分别）。GFAP首先升高，NFL提升到最高程度，无论ABI如何，Tau的变化都有限。
结论：需要进一步的研究来确定血浆生物标志物如何促进V-AECMO中ABIs的早期检测，以帮助及时做出临床决策。
