Effects of venovenous extracorporeal membrane oxygenation on cerebral oxygenation in hypercapnic ARDS

Muellenbach, R.M.; Kilgenstein, Christian; Kranke, Peter; Küstermann, J.; Kredel, Markus; Roewer, Norbert; Ernestus, RI; Westermaier, Thomas

doi:10.1177/0267659113497073

Cited by 30 publications

(25 citation statements)

References 11 publications

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“…Recently, Muellenbach et al reported that patients receiving vvECMO treatment were at risk for a decrease in cerebral regional tissue oxygen saturation at ECMO initiation, and that this decreased is linked to PaCO2 change. This could be involved in the pathogenesis of brain injury of ECMO patients [19,20]. In our study, the acute PaCO 2 change was independently associated with cerebral bleeding and one can hypothesize that these abrupt changes may have facilitated brain hemorrhages.…”

Section: Discussionsupporting

confidence: 49%

Brain injury during venovenous extracorporeal membrane oxygenation

et al. 2016

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Neurological events occurred frequently in patients on VV-ECMO. Intracranial bleeding, the most frequent, occurred early and was associated with higher mortality. Because it was independently associated with rapid hypercapnia decrease, the latter should be avoided at ECMO onset, but its exact role remains to be determined. These findings may have major implications for the care of patients requiring VV-ECMO.

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Section: Discussionsupporting

confidence: 49%

Brain injury during venovenous extracorporeal membrane oxygenation

et al. 2016

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“…14,[18][19][20][21][22] Particular care should also be devoted to avoid hyperoxia and hypocapnia just after ECLS initiation as the two conditions together may increase brain damage (reperfusion injury) or loss of cerebral perfusion autoregulation. 23,24 After the patient is stabilized, further diagnostic procedures must immediately proceed. A detailed case history must be collected.…”

Section: Post-resuscitation Carementioning

confidence: 99%

Conditions and procedures for in-hospital extracorporeal life support (ECLS) in cardiopulmonary resuscitation (CPR) of adult patients

et al. 2015

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The use of extracorporeal life support (ECLS) in cardiopulmonary resuscitation (CPR; ECPR) has been repeatedly published as non-randomized studies, mainly case series and case reports. The aim of this article is to support physicians, perfusionists, nurses and extracorporeal membrane oxygenation (ECMO) specialists who regularly perform ECPR or are willing to start an ECPR program by establishing standards for safe and efficient ECPR procedures. This article represents the experience and recommendations of physicians who provide ECPR routinely. Based on its survival and outcome rates, ECPR can be considered when determining the optimal treatment of patients who require CPR. The successful performance of ECLS cannulation during CPR is a life-saving measure and has been associated with improved outcome (including neurological outcome) after CPR. We summarize the general structure of an ECLS team and describe the cannulation procedure and the approaches for post-resuscitation care. The differences in hospital organizations and their regulations may result in variations of this model.

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“…Nonetheless, it is increasingly evident that the mechanisms underlying the occurrence are not simply linked to embolization, bleeding, or low-flow related brain hypoxia (3)(4)(5) which were thought to represent the sole source of injury of the brain in ECLS patients.…”

mentioning

confidence: 99%

“…Furthermore, the mechanisms underlying the high rate of cerebral hemorrhage experienced in V-V subjects might be different from the same event observed in V-A patients, who, instead, have higher rates of brain death and ischemic injury. The importance of altered blood gases, particularly of CO 2 clearance, in the genesis of neurologic adverse events has been underlined by several investigators (4,5,13).…”

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confidence: 99%

Extracorporeal life support and neurologic complications: still a long way to go

Lorusso

2017

J. Thorac. Dis.

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The actual impact of neurological complications on patient outcome during extracorporeal life support (ECLS) has emerged only since a few years (1,2) despite the use of such a temporary heart/lung support for more than four decades.The recent appraisal of the rather high incidence and ominous prognosis of these adverse events in ECLS patients have now alerted attending physicians and personnel upon continuous surveillance and early recognition. Nonetheless, it is increasingly evident that the mechanisms underlying the occurrence are not simply linked to embolization, bleeding, or low-flow related brain hypoxia (3-5) which were thought to represent the sole source of injury of the brain in ECLS patients.Following a study addressing the neurologic complications in the neonatal population (6), other two studies realized by analysing the Registry of the Extracorporeal Life Support Organization (ELSO), have recently investigated and clearly shown the entity of neurologic adverse events in veno-arterial (V-A) and veno-venous (V-V) ECLS configurations in adult patient populations (7,8). Incidence rates of brain injury were 15% in V-A and 7% in V-V patients, respectively, with an in-hospital survival of 10% in the first group, and 25% in the second, underlining the ominous prognosis once a neurological event occurs in the ECLS patients (7,8). These studies analyzed also the type of brain damage, according to the ELSO reporting system (embolism, hemorrhage, seizures, brain death) but also, more importantly, the trends of the overall CNS complications and of the single typerelated rates of such adverse events during a 20-year period whose assessment provided interesting findings (7,8).The difference of neurologic complication rates between V-A and V-V is not surprising. However, the two studies, as also highlighted by the comments provided by Pappalardo, Hirose, and Perico herewith enclosed (9-11), have provided several relevant clues for further interpretation and discussion. Interestingly, the incidence of CNS events in V-A ECLS patients steadily declined in the recent years, whereas no substantial change was observed in the V-V ECLS population (7,8). It is well-known that patients undergoing V-A ECLS, by definition and as also confirmed by the ELSO Registry data, are usually more prone to experience bleeding and hemodynamic instability after ECLS implant than V-V cases, therefore at higher risk also for brain injury. This is due to either the underlying disease, settings, and clinical conditions of the ECLS candidates or to the ECLS access (arterial cannulation certainly at higher risk of bleeding than venous access). V-A ECLS, indeed, is often applied nowadays in patients suffering from cardiac arrest, condition which is directly linked to brain hypoperfusion

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Effects of venovenous extracorporeal membrane oxygenation on cerebral oxygenation in hypercapnic ARDS

Cited by 30 publications

References 11 publications

Brain injury during venovenous extracorporeal membrane oxygenation

Brain injury during venovenous extracorporeal membrane oxygenation

Conditions and procedures for in-hospital extracorporeal life support (ECLS) in cardiopulmonary resuscitation (CPR) of adult patients

Extracorporeal life support and neurologic complications: still a long way to go

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