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Review
. 2018 Mar 18:2018:3237810.
doi: 10.1155/2018/3237810. eCollection 2018.

Cerebral Pathophysiology in Extracorporeal Membrane Oxygenation: Pitfalls in Daily Clinical Management

Syed Omar Kazmi  1 , Sanjeev Sivakumar  2 , Dimitrios Karakitsos  3   4 , Abdulrahman Alharthy  3 , Christos Lazaridis  1
Affiliations
Review

Cerebral Pathophysiology in Extracorporeal Membrane Oxygenation: Pitfalls in Daily Clinical Management

Syed Omar Kazmi et al. Crit Care Res Pract. .

Abstract

Extracorporeal membrane oxygenation (ECMO) is a life-saving technique that is widely being used in centers throughout the world. However, there is a paucity of literature surrounding the mechanisms affecting cerebral physiology while on ECMO. Studies have shown alterations in cerebral blood flow characteristics and subsequently autoregulation. Furthermore, the mechanical aspects of the ECMO circuit itself may affect cerebral circulation. The nature of these physiological/pathophysiological changes can lead to profound neurological complications. This review aims at describing the changes to normal cerebral autoregulation during ECMO, illustrating the various neuromonitoring tools available to assess markers of cerebral autoregulation, and finally discussing potential neurological complications that are associated with ECMO.

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Figures

Figure 1
Figure 1
Lassen curve of autoregulation depicting variations of cerebral blood flow (CBF) over a range of cerebral perfusion pressures (CPP). Point A is the lower limit of the curve (LLA) after which a decrease in CPP will lead to reductions in CBF. Point B is the higher limit of the curve (HLA) after which an increase in CPP with increase CBF. The range of CPP depicted by X is the zone of autoregulation where the CBF remains constant over changes in CPP. This is regulated by vasoconstriction and vasodilation of cerebral arterioles.
Figure 2
Figure 2
TCD waveforms of a patient on venovenous- (VV-) ECMO. Low mean cerebral blood flow velocities are observed in bilateral middle cerebral artery distributions with normal pulsatility indices. L-MCA: left middle cerebral artery; R-MCA: right middle cerebral artery; PI: pulsatility index.
Figure 3
Figure 3
TCD waveforms of a patient on venoarterial- (VA-) ECMO. Low mean cerebral blood flow velocities are observed in bilateral middle cerebral artery distributions along with low pulsatility indices. L-MCA: left middle cerebral artery; R-MCA: right middle cerebral artery; PI: pulsatility index.
See this image and copyright information in PMC

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