REVIEW   Free access

Minerva Anestesiologica 2017 October;83(10):1061-74

DOI: 10.23736/S0375-9393.17.11911-5

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

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

Roberto LORUSSO ¹ ✉, Fabio S. TACCONE ², Mirko BELLIATO ³, Thijs DELNOIJ ⁴, Paolo ZANATTA ⁵, Mirjana CVETKOVIC ⁶, Mark DAVIDSON ⁷, Jan BELOHLAVEK ⁸, Nashwa MATTA ⁹, Carl DAVIS ¹⁰, Hanneke IJSSELSTIJN ¹¹, Thomas MUELLER ¹², Ralf MUELLENBACH ¹³, Dirk DONKER ¹⁴, Piero DAVID ¹⁵, Matteo DI NARDO ¹⁶, Dirk VLASSELAERS ¹⁷, Dinis dos REIS MIRANDA ¹⁸, Aparna HOSKOTE ¹⁹ on behalf of Euro-ELSO Working Group on Neurologic Monitoring and Outcome

¹ Department of Cardio-Thoracic Surgery, Heart and Vascular Center, Maastricht University Medical Center, Maastricht, The Netherlands; ² Department of Intensive Care Medicine, Université Libre de Bruxelles, Hopital Erasme, Bruxelles, Belgium; ³ 2nd Intensive Care Unit, S.C. Anestesia e Rianimazione, Foundation IRCCS S. Matteo, Pavia, Italy; ⁴ Department of Cardiology and Department of Intensive Care Unit, Maastricht University Medical Center, Maastricht, The Netherlands; ⁵ Department of Anesthesia and Intensive Care, Intraoperative Neurophysiology, Treviso Regional Hospital, Treviso, Italy; ⁶ Pediatric Intensive Care Unit, Glenfield Hospital, Leicester, UK; ⁷ Intensive Care Unit, Royal Hospital for Sick Children, Glasgow, Scotland; ⁸ Second Department of Medicine, Cardiovascular Medicine, General Teaching Hospital, Charles University, Prague, Czech Republic; ⁹ Neonatal Unit, Princess Royal Maternity, Glasgow, Scotland; ¹⁰ Surgery Unit, Royal Hospital for Sick Children, Glasgow, Scotland; ¹¹ Pediatric Surgery and Intensive Care, Erasmus MC - Sophia Children’s Hospital, Rotterdam, The Netherlands; ¹² Department of Internal Medicine, University Hospital of Regensburg, Germany; ¹³ Department of Intensive Care, Kassel, Germany; ¹⁴ Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands; ¹⁵ Cardiac Anesthesia and Intensive Care Unit, Sant’Andrea Hospital, Rome, Italy; ¹⁶ Pediatric Intensive Care Unit, Children’s Hospital Bambino Gesù, IRCCS, Rome, Italy; ¹⁷ Department of Intensive Care Medicine, University Hospitals, Leuven, Belgium; ¹⁸ Department of Intensive Care, Erasmus Medical Center, University Medical Center Rotterdam, The Netherlands; ¹⁹ Cardiac Intensive Care and ECMO, Institute of Child Health, Great Ormond Street Hospital, London, UK

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, and 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.

KEY WORDS: Extracorporeal membrane oxygenation - Complications - Neurophysiological monitoring