Brain monitoring in adult and pediatric ECMO patients: The importance of early and late assessments

Roberto Lorusso, Fabio S. Tacco Ne, Mirko Belliato, Thijs Delnoij, Paolo Zanatta, Mirjana Cvetkovic, Mark Davidson, Jan Belohlavek, Nashwa Matta, Carl Davis, Hanneke Ijsselstijn, Thomas Mueller, Ralf Muellenbach, Dirk Donker, Piero David, Matteo Di Nardo, Dirk Vlasselaers, Dinis Dos Reis Miranda, Aparna Hoskote

Research output: Contribution to journalReview article

Abstract

Monitoring brain integrity and neurocognitive function is a new and important target for the management of a patient treated with extracorporeal membrane oxygenation (ECMO), in particular because of the increasing awareness of cerebral abnormalities that may potentially occur in this setting. Continuous regular monitoring, as well as repeated assessment for cerebral complications has become an essential element of the ECMO patient management. Besides well-known complications, like bleeding, ischemic stroke, seizures, and brain hypoperfusion, other less defined yet relevant injury and clinical manifestations are increasingly reported and impacting on ECMO patient prognosis at short term. Furthermore, it is becoming more evident that neurologic complication may not occur only in the early phase. Indeed, other potential adverse events related to the long-Term neurocognitive function have been also recently documented either in children or adult ECMO patients. Despite increasing awareness of these aspects, generally accepted protocols and clinical management strategies in this respect are still lacking. Current means to monitor brain perfusion or detecting ongoing cerebral tissue injury are rather limited, and most techniques provide indirect or post-insult recognition of irreversible tissue injury. Continuous monitoring of brain perfusion, serial assessment of brain-derived serum biomarkers, timely neuro-imaging, profesand post-discharge counselling for neurocognitive dysfunction, particularly in pediatric patients, are novel pathways focusing on neurologic assessment with important implications in daily practice to assess brain function and integrity not only during the ECMO-related hospitalization, but also at long-Term to re-evaluate the neuropsychological integrity, although well designed studies will be necessary to elucidate the cost-effectiveness of these management strategies.

Original languageEnglish
Pages (from-to)1061-1074
Number of pages14
JournalMinerva Anestesiologica
Volume83
Issue number10
DOIs
Publication statusPublished - Oct 1 2017

Keywords

  • Complications
  • Extracorporeal membrane oxygenation
  • Neurophysiological monitoring.

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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    Lorusso, R., Tacco Ne, F. S., Belliato, M., Delnoij, T., Zanatta, P., Cvetkovic, M., Davidson, M., Belohlavek, J., Matta, N., Davis, C., Ijsselstijn, H., Mueller, T., Muellenbach, R., Donker, D., David, P., Di Nardo, M., Vlasselaers, D., Dos Reis Miranda, D., & Hoskote, A. (2017). Brain monitoring in adult and pediatric ECMO patients: The importance of early and late assessments. Minerva Anestesiologica, 83(10), 1061-1074. https://doi.org/10.23736/S0375-9393.17.11911-5