Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jun;165(6):2104-2110.e1.
doi: 10.1016/j.jtcvs.2021.09.063. Epub 2021 Oct 30.

Neuromonitoring detects brain injury in patients receiving extracorporeal membrane oxygenation support

Chin Siang Ong  1 , Eric Etchill  1 , Jie Dong  1 , Benjamin L Shou  1 , Leah Shelley  2 , Katherine Giuliano  1 , Mais Al-Kawaz  2 , Eva K Ritzl  2 , Romergryko G Geocadin  2 , Bo Soo Kim  3 , Errol L Bush  4 , Chun Woo Choi  1 , Glenn J R Whitman  1 , Sung-Min Cho  5
Affiliations
Free article

Neuromonitoring detects brain injury in patients receiving extracorporeal membrane oxygenation support

Chin Siang Ong et al. J Thorac Cardiovasc Surg. 2023 Jun.
Free article

Abstract

Objective: There is limited evidence on standardized protocols for optimal neurological monitoring methods in patients receiving extracorporeal membrane oxygenation (ECMO). We previously introduced protocolized noninvasive multimodal neuromonitoring using serial neurological examinations, electroencephalography, transcranial Doppler ultrasound, and somatosensory evoked potentials. The purpose of this study was to examine if standardized neuromonitoring is associated with detection of acute brain injury (ABI) and improved patient outcomes.

Methods: A retrospective analysis of ECMO patients who received neurocritical care consultation was performed and outcomes were reviewed. The cohort was stratified according to those who did not receive standardized neuromonitoring (era 1: 2016-2017) and those who received standardized neuromonitoring (era 2: 2017-2020). Multivariable logistic regression was used to evaluate the association between standardized neuromonitoring and ABI.

Results: A total of 215 patients (mean age, 54 years; 60% male) underwent ECMO (71% venoarterial-ECMO) in our institution, 70 in era 1 and 145 in era 2. The proportion of patients diagnosed with ABI were 23% in era 1 and 33% in era 2 (P = .12). In multivariable logistic regression, standardized neuromonitoring (odds ratio, 2.24; 95% CI, 1.12-4.48; P = .02) and pre-ECMO cardiac arrest (odds ratio, 2.17; 95% CI, 1.14-4.14; P = .02) were independently associated with ABI. There was a greater proportion of patients with good neurological outcomes when discharged alive in era 2 (54% vs 30%; P = .04).

Conclusions: Standardized neuromonitoring was associated with increased ABIs in ECMO patients. Although neuromonitoring does not prevent ABI from occurring, it might prevent worsening with timely interventions (eg, anticoagulation management, optimizing oxygen delivery and blood pressure), leading to improved neurological outcomes at discharge.

Keywords: ECMO; acute brain injury; extracorporeal membrane oxygenation; neurological complication; neurological injury; neurological outcome; noninvasive multimodal neuromonitoring.

PubMed Disclaimer

Comment in