Neurological injury in adults treated with extracorporeal membrane oxygenation.
ABSTRACT Extracorporeal membrane oxygenation (ECMO) may be urgently used as a last resort form of life support when all other treatment options for potentially reversible cardiopulmonary injury have failed.
To examine the range and frequency of neurological injury in ECMO-treated adults.
Retrospective clinicopathological cohort study.
Mayo Clinic, Rochester, Minnesota.
A prospectively collected registry of all patients 15 years or older treated with ECMO for 12 or more hours from January 2002 to April 2010.
Patients were analyzed for potential risk factors for neurological events and death using logistic regression and Cox proportional hazards models.
Neurological diagnosis and/or death.
A total of 87 adults were treated (35 female [40%]; median age, 54 years [interquartile range, 31]; mean duration of ECMO, 91 hours [interquartile range, 100]; overall survival >7 days after ECMO, 52%). Neurological events occurred in 42 patients who received ECMO (50%; 95% confidence interval [CI], 39%-61%). Diagnoses included subarachnoid hemorrhage, ischemic watershed infarctions, hypoxic-ischemic encephalopathy, unexplained coma, and brain death. Death in patients who received ECMO who did not require antecedent cardiopulmonary resuscitation was associated with increased age (odds ratio, 1.24 per decade; 95% CI, 1.03-1.50; P = .02) and lower minimum arterial oxygen pressure (odds ratio, 0.79; 95% CI, 0.68-0.92; P = .03). Although stroke was rarely diagnosed clinically, 9 of 10 brains studied at autopsy demonstrated hypoxic-ischemic and hemorrhagic lesions of vascular origin.
Severe neurological sequelae occur frequently in adult ECMO-treated patients with otherwise reversible cardiopulmonary injury (conservative estimate, 50%) and include a range of potentially fatal neurological diagnoses that may be due to the precipitating event and/or ECMO treatment.
- SourceAvailable from: Luciano Cesar AzevedoClinics (São Paulo, Brazil) 12/2012; 67(12):1511-5. · 1.59 Impact Factor
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ABSTRACT: BACKGROUND: Apnea test is a key component to confirm brain death. For patients receiving extracorporeal membrane oxygenation (ECMO), apnea test remains challenging. Brain death (BD) diagnosis is often made without apnea test. CASE: We report the case of a 29-year-old man presenting clinical signs of BD while treated with ECMO therapy for refractory cardiogenic shock. Decreasing the ECMO sweep gas flow from 3 to 1 L/min and increasing oxygen delivery to 100 % on ECMO during the apnea test have allowed increasing the PaCO2 of more than 20 mmHg without decreasing PaO2. DISCUSSION: In order to diagnose BD, neurological examination should be complete, including apnea testing, which can be not possible in patients receiving ECMO due to CO2 removal from the membrane. Decreasing sweep gas rate allows reduction in CO2 diffusion through the membrane. However, decreasing the ECMO gas flow to zero could be insufficient to maintain normoxemia. Decreasing (but not stopping) the sweep gas flow to 1 L/min and increasing the oxygen delivery through the ECMO have allowed performing the apnea test safely. CONCLUSION: To assess brain death in patients on ECMO, apnea test can be performed without compromising oxygenation by decreasing (but not stopping) the sweep gas flow and increasing oxygen delivery through the membrane.Neurocritical Care 04/2013; · 3.04 Impact Factor
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ABSTRACT: To investigate if serum S100B protein levels could early detect cerebral complications under treatment extracorporeal membrane oxygenation (ECMO). Serum S100B levels were measured over 5 days in 32 patients with cardiogenic and septic shock, including 15 patients who treated by ECMO and 17 who did not. Cerebral complications included hemorrhage, stroke, encephalopathy with myoclonus, and brain death. Delirium was identified by the positive Confusion Assessment Method in the ICU. S100B levels were elevated in 24/32 patients (75 %) at ICU admission. Five patients developed cerebral complications (2 hemorrhages with 1 brain death, 1 encephalopathy with myoclonus in the ECMO group and 2 strokes in the non-ECMO group). At day 5, S100B levels were higher in the 5 patients with cerebral complications than in the 27 without cerebral complications, regardless of ECMO (0.426 [0.421, 0.652] vs. 0.102 [0.085, 0.135] μg/L, p = 0.011). S100B levels were also more elevated in 3 patients with than in 12 without cerebral complications associated with ECMO (0.799 [0.325, 0.965] vs. 0.102 [0.09, 0.607] μg/L, p = 0.033). S100B levels were not associated with delirium after sedation withdrawal. Measurement serum S100B could be useful to detect cerebral complications in deeply sedated patients associated with ECMO but not for monitoring delirium after sedation withdrawal.Neurocritical Care 07/2013; · 3.04 Impact Factor