PDF(Pubmed)
Abstract：
Introduction Extracorporeal membrane oxygenation (ECMO) is associated with a high rate of neurologic complications. Multimodal neurologic monitoring (MNM) has the potential for early detection and intervention. We examined the safety and feasibility of noninvasive MNM during ECMO. We hypothesized that survivors and non-survivors would have meaningful differences in transcranial Doppler (TCD) sonography and electroencephalographic (EEG) characteristics, which we aimed to identify. We also investigated adverse neurologic events and attempted to identify differences in EEG and TCD characteristics among patients based on the type of ECMO and the occurrence of these events. Material and methods We performed an observational study on all patients undergoing ECMO at Baylor St. Luke\'s Medical Center\'s critical care unit in Houston, Texas, United States, from January 2017 to February 2019. All patients underwent a noninvasive MNM protocol. Results NM was completed in 75% of patients; all patients received at least one component of the monitoring protocol. No adverse events were noted, showing the feasibility and safety of the protocol. The 60.4% of patients who did not survive tended to be older, had lower ejection fractions, and had lower median right middle cerebral artery (MCA) pulsatility and resistivity indexes. Patients undergoing venoarterial (VA)-ECMO had lower median left and right MCA velocities and lower right Lindegaard ratios than patients who underwent venovenous-ECMO. In VA-ECMO patients, EEG less often showed sleep architecture, while other findings were similar between groups. Adverse neurologic events occurred in 24.7% of patients, all undergoing VA-ECMO. Acute ischemic stroke occurred in 22% of patients, intraparenchymal hemorrhage in 4.9%, hypoxic-ischemic encephalopathy in 3.7%, subarachnoid hemorrhage in 2.5%, and subdural hematoma in 1.2%. Conclusion Our results suggest that MNM is safe and feasible for patients undergoing ECMO. Certain EEG and TCD findings could aid in the early detection of neurologic deterioration. MNM may not just be used in monitoring patients undergoing ECMO but also in prognostication and aiding clinical decision-making.
摘要：
简介体外膜氧合（ECMO）与高发生率的神经系统并发症有关。多模态神经监测（MNM）具有早期发现和干预的潜力。我们检查了ECMO期间无创MNM的安全性和可行性。我们假设幸存者和非幸存者在经颅多普勒超声（TCD）和脑电图（EEG）特征方面会有有意义的差异，我们旨在识别。我们还调查了不良神经系统事件，并试图根据ECMO的类型和这些事件的发生来确定患者之间EEG和TCD特征的差异。材料和方法我们在休斯顿贝勒圣卢克医疗中心重症监护病房对所有接受ECMO的患者进行了观察性研究，德州,美国,从2017年1月到2019年2月。所有患者均接受非侵入性MNM方案。结果75％的患者完成了NM；所有患者至少接受了监测方案的一个组成部分。没有注意到不良事件，证明了该方案的可行性和安全性。60.4%没有存活的患者往往年龄较大，射血分数较低，右大脑中动脉（MCA）搏动性和电阻率指数较低。与接受静脉-ECMO的患者相比，接受静脉动脉（VA）-ECMO的患者的左，右MCA中位速度和右Lindegaard比值较低。在VA-ECMO患者中，脑电图很少显示睡眠结构，而其他发现组间相似。24.7％的患者发生不良神经系统事件，全部接受VA-ECMO。22％的患者发生急性缺血性卒中，实质内出血4.9%，缺氧缺血性脑病占3.7%,蛛网膜下腔出血2.5%,硬膜下血肿占1.2%。结论我们的结果表明，MNM对于接受ECMO的患者是安全可行的。某些EEG和TCD发现有助于早期发现神经系统恶化。MNM不仅可以用于监测接受ECMO的患者，还可以用于预测和帮助临床决策。
