Impairment of cerebral autoregulation in pediatric extracorporeal membrane oxygenation associated with neuroimaging abnormalities.

Chul Ahn,Fenghua Tian,Hanli Liu,Lakshmi Raman,Lina Chalak,Michael Craig Morriss,Ramgopal Venkataraman

doi:10.1117/1.nph.4.4.041410

Abstract

.Extracorporeal membrane oxygenation (ECMO) is a life-supporting therapy for critically ill patients with severe respiratory and/or cardiovascular failure. Cerebrovascular impairment can result in hemorrhagic and ischemic complications commonly seen in the patients supported on ECMO. We investigated the degree of cerebral autoregulation impairment during ECMO as well as whether it is predictive of neuroimaging abnormalities. Spontaneous fluctuations of mean arterial pressure (MAP) and cerebral tissue oxygen saturation () were continuously measured during the ECMO run. The dynamic relationship between the MAP and fluctuations was assessed based on wavelet transform coherence (WTC). Neuroimaging was conducted during and/or after ECMO as standard of care, and the abnormalities were evaluated based on a scoring system that had been previously validated among ECMO patients. Of the 25 patients, 8 (32%) had normal neuroimaging, 7 (28%) had mild to moderate neuroimaging abnormalities, and the other 10 (40%) had severe neuroimaging abnormalities. The degrees of cerebral autoregulation impairment quantified based on WTC showed significant correlations with the neuroimaging scores (; ). Evidence that cerebral autoregulation impairment during ECMO was related to the patients’ neurological outcomes was provided.

Highlights

IntroductionExtracorporeal membrane oxygenation (ECMO)[1] is a life-supporting therapy for critically ill patients with severe respiratory and/or cardiovascular failure
Extracorporeal membrane oxygenation (ECMO)[1] is a life-supporting therapy for critically ill patients with severe respiratory and/or cardiovascular failure. It is used as part of cardiopulmonary resuscitation (CPR) when conventional CPR fails
The healthy brain is protected by cerebral autoregulation, which maintains an adequate cerebral blood flow (CBF) in face of blood pressure changes.[5]

Summary

Introduction

Extracorporeal membrane oxygenation (ECMO)[1] is a life-supporting therapy for critically ill patients with severe respiratory and/or cardiovascular failure. The healthy brain is protected by cerebral autoregulation, which maintains an adequate cerebral blood flow (CBF) in face of blood pressure changes.[5] Pre-ECMO factors, such as hypoxia, hypercarbia, and hypertension, can disrupt blood flow regulation, leaving the brain vulnerable to changes in blood pressure.[6] Cannulation of great blood vessels[7,8] and alterations of pulsatile flow patterns[9] during ECMO play a role in altered cerebral autoregulation. Both pre- and intra-ECMO factors can result in hemorrhagic and ischemic complications

Methods

Results

Conclusion