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Review
. 2021;23(5):15.
doi: 10.1007/s11940-021-00671-7. Epub 2021 Mar 31.

Evaluation, Treatment, and Impact of Neurologic Injury in Adult Patients on Extracorporeal Membrane Oxygenation: a Review

Benjamin Illum  1 , Mazen Odish  2 , Anushirvan Minokadeh  1   3 , Cassia Yi  4 , Robert L Owens  2 , Travis Pollema  5 , Jamie Nicole LaBuzetta  1
Affiliations
Review

Evaluation, Treatment, and Impact of Neurologic Injury in Adult Patients on Extracorporeal Membrane Oxygenation: a Review

Benjamin Illum et al. Curr Treat Options Neurol. 2021.

Abstract

Purpose: Extracorporeal membrane oxygen (ECMO) is increasingly used as an advanced form of life support for cardiac and respiratory failure. Unfortunately, in infrequent instances, circulatory and/or respiratory recovery is overshadowed by neurologic injury that can occur in patients who require ECMO. As such, knowledge of ECMO and its implications on diagnosis and treatment of neurologic injuries is indispensable for intensivists and neurospecialists.

Recent findings: The most common neurologic injuries include intracerebral hemorrhage, ischemic stroke, seizure, cerebral edema, intracranial hypertension, global cerebral hypoxia/anoxia, and brain death. These result from events prior to initiation of ECMO, failure of ECMO to provide adequate oxygen delivery, and/or complications that occur during ECMO. ECMO survivors also experience neurological and psychological sequelae similar to other survivors of critical illness.

Summary: Since many of the risk factors for neurologic injury cannot be easily mitigated, early diagnosis and intervention are crucial to limit morbidity and mortality from neurologic injury during ECMO.

Keywords: Acute brain injury; Complications; ECMO; Extracorporeal membrane oxygenation; Hemorrhage; Neurological disorder.

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Conflict of interest statement

Conflict of interestDr. Illum reports no disclosures. Dr. Odish reports no disclosures. Dr. Minokadeh reports no disclosures. Dr. Owens reports funding from the NIH. Cassia Yi reports no disclosures. Dr. Pollema reports no disclosures. Dr. LaBuzetta reports no disclosures.

Figures

Fig. 1
Fig. 1
Annual numbers of ECMO centers and ECMO cases in the USA reported to Extracorporeal Life Support Organization. The number of ECMO cases in 2019 is under-reported at the time of this review.
Fig. 2
Fig. 2
(a) Veno-venous (V-V) ECMO with a duel site cannulation. Drainage cannula inserted into the right femoral vein and return cannula in the right internal jugular vein. (b) Veno-arterial (V-A) ECMO, with a duel site cannulation, with the drainage cannula inserted into the right femoral vein, and the return cannula to the left femoral artery. Credit: Catherine Cichon, MD, MPH.
Fig. 3
Fig. 3
Sedation guidelines, adapted from Extracorporeal Life Support Organization recommendations with modifications. NMB, neuromuscular blockade.
See this image and copyright information in PMC

References

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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