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. 2023 Apr;38(3):547-556.
doi: 10.1177/02676591211066804. Epub 2022 Feb 25.

Feasibility of non-invasive neuro-monitoring during extracorporeal membrane oxygenation in children

William M McDevitt  1 , Margaret Farley  2 , Darren Martin-Lamb  1 , Timothy J Jones  3   4 , Kevin P Morris  2   5 , Stefano Seri  1   6 , Barnaby R Scholefield  2   7
Affiliations

Feasibility of non-invasive neuro-monitoring during extracorporeal membrane oxygenation in children

William M McDevitt et al. Perfusion. 2023 Apr.

Abstract

Introduction: Detection of neurological complications during extracorporeal membrane oxygenation (ECMO) may be enhanced with non-invasive neuro-monitoring. We investigated the feasibility of non-invasive neuro-monitoring in a paediatric intensive care (PIC) setting.

Methods: In a single centre, prospective cohort study we assessed feasibility of recruitment, and neuro-monitoring via somatosensory evoked potentials (SSEP), electroencephalography (EEG) and near infrared spectroscopy (NIRS) during venoarterial (VA) ECMO in paediatric patients (0-15 years). Measures were obtained within 24h of cannulation, during an intermediate period, and finally at decannulation or echo stress testing. SSEP/EEG/NIRS measures were correlated with neuro-radiology findings, and clinical outcome assessed via the Pediatric cerebral performance category (PCPC) scale 30 days post ECMO cannulation.

Results: We recruited 14/20 (70%) eligible patients (median age: 9 months; IQR:4-54, 57% male) over an 18-month period, resulting in a total of 42 possible SSEP/EEG/NIRS measurements. Of these, 32/42 (76%) were completed. Missed recordings were due to lack of access/consent within 24 h of cannulation (5/42, 12%) or PIC death/discharge (5/42, 12%). In each patient, the majority of SSEP (8/14, 57%), EEG (8/14, 57%) and NIRS (11/14, 79%) test results were within normal limits. All patients with abnormal neuroradiology (4/10, 40%), and 6/7 (86%) with poor outcome (PCPC ≥4) developed indirect SSEP, EEG or NIRS measures of neurological complications prior to decannulation. No study-related adverse events or neuro-monitoring data interpreting issues were experienced.

Conclusion: Non-invasive neuro-monitoring (SSEP/EEG/NIRS) during ECMO is feasible and may provide early indication of neurological complications in this high-risk population.

Keywords: Somatosensory evoked potential; electroencephalography; extracorporeal membrane oxygenation; near infrared spectroscopy; neuro-monitoring; neurological injury; prognostication.

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