TY - JOUR
T1 - Brain monitoring in adult and pediatric ECMO patients
T2 - the importance of early and late assessments
AU - Lorusso, Roberto
AU - Taccone, Fabio S.
AU - Beliato, Mirko
AU - Delnoij, Thijs
AU - Zanatta, Paolo
AU - Cvetkovic, Mirjana
AU - Davidson, Mark
AU - Belohlavek, Jan
AU - Matta, Nashwa
AU - Davis, Carl
AU - Ijsselstijn, Hanneke
AU - Mueller, Thomas
AU - Muelenbach, Ralf
AU - Donker, Dirk
AU - David, Piero
AU - Di Nardo, Matteo
AU - Vlasselaers, Dirk
AU - dos Reis Miranda, Dinis
AU - Hoskote, Aparna
AU - Euro-ELSO Working Grp Neurologic M
PY - 2017/10
Y1 - 2017/10
N2 - Monitoring brain integrity and neurocognitive function is a new and important target for the management of a patient treated with extracorporeal membrane oxygenation (ECMO), in particular because of the increasing awareness of cerebral abnormalities that may potentially occur in this setting. Continuous regular monitoring, as well as repeated assessment for cerebral complications has become an essential element of the ECMO patient management. Besides well-known complications, like bleeding, ischemic stroke, seizures, and brain hypoperfusion, other less defined yet relevant injury and clinical manifestations are increasingly reported and impacting on ECMO patient prognosis at short term. Furthermore, it is becoming more evident that neurologic complication may not occur only in the early phase. Indeed, other potential adverse events related to the long-term neurocognitive function have been also recently documented either in children or adult ECMO patients. Despite increasing awareness of these aspects, generally accepted protocols and clinical management strategies in this respect are still lacking. Current means to monitor brain perfusion or detecting ongoing cerebral tissue injury are rather limited, and most techniques provide indirect or post-insult recognition of irreversible tissue injury. Continuous monitoring of brain perfusion, serial assessment of brain-derived serum biomarkers, timely neuro-imaging, and post-discharge counselling for neurocognitive dysfunction, particularly in pediatric patients, are novel pathways focusing on neurologic assessment with important implications in daily practice to assess brain function and integrity not only during the ECMO-related hospitalization, but also at long-term to re-evaluate the neuropsychological integrity, although well designed studies will be necessary to elucidate the cost-effectiveness of these management strategies.
AB - Monitoring brain integrity and neurocognitive function is a new and important target for the management of a patient treated with extracorporeal membrane oxygenation (ECMO), in particular because of the increasing awareness of cerebral abnormalities that may potentially occur in this setting. Continuous regular monitoring, as well as repeated assessment for cerebral complications has become an essential element of the ECMO patient management. Besides well-known complications, like bleeding, ischemic stroke, seizures, and brain hypoperfusion, other less defined yet relevant injury and clinical manifestations are increasingly reported and impacting on ECMO patient prognosis at short term. Furthermore, it is becoming more evident that neurologic complication may not occur only in the early phase. Indeed, other potential adverse events related to the long-term neurocognitive function have been also recently documented either in children or adult ECMO patients. Despite increasing awareness of these aspects, generally accepted protocols and clinical management strategies in this respect are still lacking. Current means to monitor brain perfusion or detecting ongoing cerebral tissue injury are rather limited, and most techniques provide indirect or post-insult recognition of irreversible tissue injury. Continuous monitoring of brain perfusion, serial assessment of brain-derived serum biomarkers, timely neuro-imaging, and post-discharge counselling for neurocognitive dysfunction, particularly in pediatric patients, are novel pathways focusing on neurologic assessment with important implications in daily practice to assess brain function and integrity not only during the ECMO-related hospitalization, but also at long-term to re-evaluate the neuropsychological integrity, although well designed studies will be necessary to elucidate the cost-effectiveness of these management strategies.
KW - Extracorporeal membrane oxygenation
KW - Complications
KW - Neurophysiological monitoring
KW - EXTRACORPOREAL MEMBRANE-OXYGENATION
KW - NEAR-INFRARED SPECTROSCOPY
KW - AMPLITUDE-INTEGRATED ELECTROENCEPHALOGRAPHY
KW - SENSORINEURAL HEARING-LOSS
KW - CRITICALLY-ILL ADULTS
KW - ELSO REGISTRY DATA
KW - LIFE-SUPPORT
KW - INTRACRANIAL HEMORRHAGE
KW - CARDIAC-ARREST
KW - NEONATAL ECMO
U2 - 10.23736/S0375-9393.17.11911-5
DO - 10.23736/S0375-9393.17.11911-5
M3 - (Systematic) Review article
C2 - 28643997
SN - 0375-9393
VL - 83
SP - 1061
EP - 1074
JO - Minerva Anestesiologica
JF - Minerva Anestesiologica
IS - 10
ER -