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Neuromonitoring detects brain injury in patients receiving extracorporeal membrane oxygenation support

医学 体外膜肺氧合 神经重症监护 优势比 逻辑回归 经颅多普勒 回顾性队列研究 队列 冲程(发动机) 麻醉 急诊医学 内科学 机械工程 工程类
作者
Chin Siang Ong,Eric Etchill,Jie Dong,Benjamin L. Shou,Leah Shelley,Katherine Giuliano,Mais Al‐Kawaz,Eva K. Ritzl,Romergryko G. Geocadin,Bo Soo Kim,Errol L. Bush,Chun Woo Choi,Glenn Whitman,Sung‐Min Cho
出处
期刊:The Journal of Thoracic and Cardiovascular Surgery [American Association for Thoracic Surgery]
卷期号:165 (6): 2104-2110.e1 被引量:49
标识
DOI:10.1016/j.jtcvs.2021.09.063
摘要

There is limited evidence on standardized protocols for optimal neurological monitoring methods in patients receiving extracorporeal membrane oxygenation (ECMO). We previously introduced protocolized noninvasive multimodal neuromonitoring using serial neurological examinations, electroencephalography, transcranial Doppler ultrasound, and somatosensory evoked potentials. The purpose of this study was to examine if standardized neuromonitoring is associated with detection of acute brain injury (ABI) and improved patient outcomes.A retrospective analysis of ECMO patients who received neurocritical care consultation was performed and outcomes were reviewed. The cohort was stratified according to those who did not receive standardized neuromonitoring (era 1: 2016-2017) and those who received standardized neuromonitoring (era 2: 2017-2020). Multivariable logistic regression was used to evaluate the association between standardized neuromonitoring and ABI.A total of 215 patients (mean age, 54 years; 60% male) underwent ECMO (71% venoarterial-ECMO) in our institution, 70 in era 1 and 145 in era 2. The proportion of patients diagnosed with ABI were 23% in era 1 and 33% in era 2 (P = .12). In multivariable logistic regression, standardized neuromonitoring (odds ratio, 2.24; 95% CI, 1.12-4.48; P = .02) and pre-ECMO cardiac arrest (odds ratio, 2.17; 95% CI, 1.14-4.14; P = .02) were independently associated with ABI. There was a greater proportion of patients with good neurological outcomes when discharged alive in era 2 (54% vs 30%; P = .04).Standardized neuromonitoring was associated with increased ABIs in ECMO patients. Although neuromonitoring does not prevent ABI from occurring, it might prevent worsening with timely interventions (eg, anticoagulation management, optimizing oxygen delivery and blood pressure), leading to improved neurological outcomes at discharge.
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