Continuous Electroencephalography Markers of Prognostication in Comatose Patients on Extracorporeal Membrane Oxygenation

Bronder, Jay; Martinez, Nirma Carballido; Geocadin, Romergryko G.; Kim, Bo Soo; Bush, Errol L.; Whitman, Glenn; Choi, Chun Woo; Ritzl, Eva K.; Cho, Sung-Min

doi:10.1007/s12028-022-01482-7

Cited by 12 publications

(4 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previous studies have shown that the implementation of a standardized neuromonitoring protocol leads to more accurate detection of acute brain injuries during ECMO and improved neurologic outcomes at discharge. 18,45 In addition, numerous guidelines and consensus statements, including those from the American Clinical Neurophysiology Society, the American Heart Association, the European Society of Intensive Care Medicine, and the Neurocritical Care Society, have emphasized the importance of EEG monitoring in the critically ill patient population to detect and treat seizures. [46][47][48][49] Although patients on ECPR are briefly mentioned in a few of these guidelines related to cardiac arrest, there are currently no universally standardized protocols for the detection of seizures in patients specifically receiving ECMO support.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of Seizures and Association With Mortality in Adult Patients Undergoing ECMO

Hwang,

Akbar,

Premraj

et al. 2024

Neurology

Self Cite

View full text Add to dashboard Cite

Background and ObjectivesExtracorporeal membrane oxygenation (ECMO) provides lifesaving support to patients with cardiopulmonary failure. Although seizures increase mortality risks among critically ill patients broadly, studies specific to adult ECMO patients have largely been limited to single-center studies. Thus, we aimed to perform a systematic review and meta-analyses of seizure prevalence, mortality, and their associations in adult ECMO patients. MethodsPubMed, EMBASE, Cochrane trial registry, Web of Science, and SCOPUS were searched on August 5, 2023. Following the Preferred Reporting Items for Systematic Reviews and Metaanalyses guidelines, we included studies of adults undergoing venovenous ECMO (VV-ECMO), venoarterial ECMO (VA-ECMO), or extracorporeal cardiopulmonary resuscitation (ECPR) that reported seizures during ECMO. The extracted data included study characteristics, patient demographics, ECMO support, EEG monitoring, and seizures, organized by ECMO types. Forest plot and meta-regression analyses were performed. Bias assessment was performed with the Egger test and Newcastle-Ottawa Scale.

show abstract

Section: Discussionmentioning

confidence: 99%

Epidemiology of Seizures and Association With Mortality in Adult Patients Undergoing ECMO

Hwang,

Akbar,

Premraj

et al. 2024

Neurology

Self Cite

View full text Add to dashboard Cite

show abstract

“…The study also found that intact reactivity presents state changes, and fair/good variability may be associated with survival at hospital discharge. This study implies that these features are a better approach than relying on the presence of "highly malignant" patterns for neurological prognosis [62,63]. According to "The American Clinical Neurophysiology Society Consensus Statement on EEG (cEEG) in Critically Ill Adults and Children", patients on ECMO requiring sedation and paralysis are designated as a high-risk group that should be monitored by cEEG [64].…”

Section: Eegmentioning

confidence: 99%

Hypoxic-Ischemic Brain Injury in ECMO: Pathophysiology, Neuromonitoring, and Therapeutic Opportunities

Khanduja,

Kim,

Kang

et al. 2023

Cells

Self Cite

View full text Add to dashboard Cite

Extracorporeal membrane oxygenation (ECMO), in conjunction with its life-saving benefits, carries a significant risk of acute brain injury (ABI). Hypoxic-ischemic brain injury (HIBI) is one of the most common types of ABI in ECMO patients. Various risk factors, such as history of hypertension, high day 1 lactate level, low pH, cannulation technique, large peri-cannulation PaCO2 drop (∆PaCO2), and early low pulse pressure, have been associated with the development of HIBI in ECMO patients. The pathogenic mechanisms of HIBI in ECMO are complex and multifactorial, attributing to the underlying pathology requiring initiation of ECMO and the risk of HIBI associated with ECMO itself. HIBI is likely to occur in the peri-cannulation or peri-decannulation time secondary to underlying refractory cardiopulmonary failure before or after ECMO. Current therapeutics target pathological mechanisms, cerebral hypoxia and ischemia, by employing targeted temperature management in the case of extracorporeal cardiopulmonary resuscitation (eCPR), and optimizing cerebral O2 saturations and cerebral perfusion. This review describes the pathophysiology, neuromonitoring, and therapeutic techniques to improve neurological outcomes in ECMO patients in order to prevent and minimize the morbidity of HIBI. Further studies aimed at standardizing the most relevant neuromonitoring techniques, optimizing cerebral perfusion, and minimizing the severity of HIBI once it occurs will improve long-term neurological outcomes in ECMO patients.

show abstract

“…Multimodality neuromonitoring (MMM) allows for time synchronized and integrated collection and analysis of high-frequency physiologic data 8,9 . Retrospective studies investigating the utility of continuous electroencephalography (cEEG), transcranial Doppler ultrasound (TCD), or cerebral regional oximetry (rSO 2 ), and their correlations with continuous physiologic parameters in ECMO patients have found associations between altered physiologic parameters and acute brain injury as well as patient outcomes [10][11][12][13][14][15][16][17][18][19][20][21] . However, these studies have looked at these neuromonitoring tools in isolation without comparison of each other, with fewer studies describing usefulness or feasibility of combined and integrated MMM in detecting acute brain injury of pediatric ECMO patients in a prospective manner 15,22 .…”

Section: Introductionmentioning

confidence: 99%

Neurophysiologic Features Predicting Brain Injury During Pediatric ECMO Support

Hanalioglu,

Temkit,

Hildebrandt

et al. 2023

Preprint

View full text Add to dashboard Cite

Background/Objective: Extracorporeal membrane oxygenation (ECMO) provides life-saving support to critically ill patients who experience refractory cardiopulmonary failure but carries high risk of acute brain injury. We aimed to identify characteristics predicting acute brain injury in children requiring ECMO support.Methods This is a prospective observational study from 2019–2022 of pediatric ECMO patients undergoing neuromonitoring including continuous electroencephalography, cerebral oximetry, and transcranial Doppler ultrasound (TCD). Primary outcome was acute brain injury. Clinical and neuromonitoring characteristics were collected. Multivariate logistic regression was implemented to model odds ratios (OR) and identify the combined characteristics that best discriminate risk of acute brain injury using the area under the receiver operating characteristic curve (AUROC).Results Seventy-five pediatric patients requiring ECMO support were enrolled in this study. Of the seventy-five patients enrolled, nineteen experienced acute brain injury (25.3%), including seven (36.8%) with arterial ischemic stroke, four (21.1%) with hemorrhagic stroke, seven with hypoxic ischemic brain injury (36.8%) and one (5.3%) with both arterial ischemic stroke and hypoxic ischemic brain injury. Univariate analysis demonstrated acute brain injury to be associated with maximum hourly seizure burden (p = 0.026), epileptiform discharges (p = 0.020), electroencephalographic suppression ratio (p = 0.014), increased interhemispheric differences in electroencephalographic total power (p = 0.023) and amplitude (p = 0.011), and increased differences in TCD Thrombolysis in Brain Ischemia (TIBI) scores between bilateral middle cerebral arteries (p = 0.049). Best subset model selection identified increased seizure burden (OR = 3.86, partial R-squared 0.40, p = 0.013), increased quantitative electroencephalographic interhemispheric amplitude differences (OR = 2.69, partial R-squared 0.18, p = 0.007), and increased interhemispheric TCD TIBI score differences (OR = 4.97, partial R-squared 0.22, p = 0.005) to be independently predictive toward acute brain injury (AUROC = 0.92).Conclusions Increased seizure burden, increased interhemispheric differences in quantitative electroencephalographic amplitude and increased TCD TIBI scores each independently predict acute brain injury in children undergoing ECMO support.

show abstract

Continuous Electroencephalography Markers of Prognostication in Comatose Patients on Extracorporeal Membrane Oxygenation

Cited by 12 publications

References 39 publications

Epidemiology of Seizures and Association With Mortality in Adult Patients Undergoing ECMO

Epidemiology of Seizures and Association With Mortality in Adult Patients Undergoing ECMO

Hypoxic-Ischemic Brain Injury in ECMO: Pathophysiology, Neuromonitoring, and Therapeutic Opportunities

Neurophysiologic Features Predicting Brain Injury During Pediatric ECMO Support

Contact Info

Product

Resources

About