Impairment of cerebral autoregulation in pediatric extracorporeal membrane oxygenation

Lakshmi Raman

doi:10.5339/qmj.2017.swacelso.37

Abstract

Background: Extracorporeal membrane oxygenation (ECMO) is a rapidly expanding, 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. The healthy brain is protected by cerebral autoregulation, which maintains an adequate cerebral blood flow in face of blood pressure changes. 1 Pre-ECMO factors, such as hypoxia, hypercarbia, and hypertension, can disrupt blood flow regulation, leaving the brain vulnerable to changes in blood pressure. 2 Cannulation of large blood vessels 3 and alterations of pulsatile flow patterns during ECMO also play a role in altered cerebral autoregulation. 4 A reliable methodology that can assess the status of cerebral autoregulation during ECMO and provide early indication of neurological injury is critical for optimization of bedside management to improve clinical outcomes. Wavelet transform coherence (W...

Highlights

Extracorporeal membrane oxygenation (ECMO) is a rapidly expanding, life-supporting therapy for critically ill patients with severe respiratory and/or cardiovascular failure
There was a significant association between individual blood pressure variations with autoregulation indices in the children, but not in the neonates (Figure 1)
We found that intraECMO autoregulation impairments derived from Wavelet transform coherence (WTC) were apparent even before clinically observable changes occur at the bedside

Summary

Introduction

Extracorporeal membrane oxygenation (ECMO) is a rapidly expanding, life-supporting therapy for critically ill patients with severe respiratory and/or cardiovascular failure. Wavelet transform coherence (WTC) to derive an index of cerebral autoregulation impairment. The Institutional Review Board at the University of Texas Southwestern Medical Center at Dallas approved the study.

Results

Conclusion