背景:体外膜氧合(ECMO)伴急性脑损伤(ABI)患者的重症监护因缺乏高质量的临床证据而值得注意。这里,我们为ECMO支持期间和之后的成人神经系统护理(神经系统监测和管理)提供指南.
方法:本指南基于临床实践共识建议和科学声明。我们召集了一个国际多学科共识小组,包括来自体外生命支持组织(ELSO)所有章节的30名具有ECMO专业知识的临床医生科学家。我们使用了经过三轮投票的改良的Delphi程序,并要求小组成员评估推荐水平。
结果:我们确定了五个需要指导的关键临床领域:(1)神经监测,(2)插管后早期生理目标和ABI,(3)神经治疗,包括内科和外科干预,(4)神经预后,(5)神经系统随访和结果。共识产生了30个关于关键临床领域的声明和建议。我们确定了几个知识差距来塑造未来的研究工作。
结论:ABI对ECMO患者的发病率和死亡率有显著影响。特别是,早期发现和及时干预对于改善预后至关重要.这些共识建议和科学声明有助于指导ABI的神经系统监测和预防。以及ECMO相关ABI的管理策略。
BACKGROUND: Critical care of patients on extracorporeal membrane oxygenation (ECMO) with acute brain injury (ABI) is notable for a lack of high-quality clinical evidence. Here, we offer
guidelines for neurological care (neurological monitoring and management) of adults during and after ECMO support.
METHODS: These
guidelines are based on clinical practice
consensus recommendations and scientific statements. We convened an international multidisciplinary
consensus panel including 30 clinician-scientists with expertise in ECMO from all chapters of the Extracorporeal Life Support Organization (ELSO). We used a modified Delphi process with three rounds of voting and asked panelists to assess the recommendation levels.
RESULTS: We identified five key clinical areas needing guidance: (1) neurological monitoring, (2) post-cannulation early physiological targets and ABI, (3) neurological therapy including medical and surgical intervention, (4) neurological prognostication, and (5) neurological follow-up and outcomes. The
consensus produced 30 statements and recommendations regarding key clinical areas. We identified several knowledge gaps to shape future research efforts.
CONCLUSIONS: The impact of ABI on morbidity and mortality in ECMO patients is significant. Particularly, early detection and timely intervention are crucial for improving outcomes. These
consensus recommendations and scientific statements serve to guide the neurological monitoring and prevention of ABI, and management strategy of ECMO-associated ABI.