Impairment of cerebral autoregulation in pediatric extracorporeal membrane oxygenation associated with neuroimaging abnormalities

Abstract

Abstract. Extracorporeal membrane oxygenation (ECMO) is a 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. We investigated the degree of cerebral autoregulation impairment during ECMO as well as whether it is predictive of neuroimaging abnormalities. Spontaneous fluctuations of mean arterial pressure (MAP) and cerebral tissue oxygen saturation (S ct O 2 ) were continuously measured during the ECMO run. The dynamic relationship between the MAP and S ct O 2 fluctuations was assessed based on wavelet transform coherence (WTC). Neuroimaging was conducted during and/or after ECMO as standard of care, and the abnormalities were evaluated based on a scoring system that had been previously validated among ECMO patients. Of the 25 patients, 8 (32%) had normal neuroimaging, 7 (28%) had mild to moderate neuroimaging abnormalities, and the other 10 (40%) had severe neuroimaging abnormalities. The degrees of cerebral autoregulation impairment quantified based on WTC showed significant correlations with the neuroimaging scores (R ¼ 0.66; p < 0.0001). Evidence that cerebral autoregulation impairment during ECMO was related to the patients' neurological outcomes was provided. © The Authors. Published by SPIE under a Creative Commons Attribution 3.0 Unported License. Distribution or reproduction of this work in whole or in part requires full attribution of the original publication, including its DOI.

Noninvasive optical measurement of microvascular cerebral hemodynamics and autoregulation in the neonatal ECMO patient

“…, ~50% of neonates with ‘normal’ ultrasounds have abnormal MRI post-ECMO ( 20 ). Although a few studies have used oxygen saturation to investigate cerebral perfusion ( 6 – 8 ), there is limited understanding of adequate cerebral perfusion during ECMO ( 10 , 21 ) or Page 7 of 33 the normative blood pressure range of CA ( 9 ). DCS and FD-DOS are promising tools to address these needs.…”

A Pilot Study Identifying Brain-Targeting Adaptive Immunity in Pediatric Extracorporeal Membrane Oxygenation Patients With Acquired Brain Injury

“…Pediatric patients on ECMO exhibit disturbances in cerebral autoregulation (17), which is the brain’s ability to maintain constant CBF despite changes in systemic blood pressure (18). Continuous near-infrared spectroscopy bedside monitoring can identify disrupted cerebral autoregulation for several diseases associated with secondary neurologic injury, including ECMO (17, 19, 20). In our patient population, 13 patients were simultaneously enrolled in an observational study to monitor cerebral autoregulation over the course of ECMO, including six ECMO patients without brain injury, and seven with acquired brain injury.…”

“…For the first time, we show in this pilot study that pediatric ECMO results in the loss of cerebral autoregulation concomitant with a robust mobilization and activation of adaptive immune cells, detection of CNS-targeting adaptive immune responses, and induction of pro-inflammatory cell signaling predominantly in patients that present with acquired brain injury. We previously reported that acquired brain injuries could be predicted by loss of cerebral autoregulation in pediatric ECMO patients (17). What is critical to consider is that as cerebral autoregulation is disrupted, the blood flow in the brain is no longer constant but fluctuates similar to the systemic circulation.…”

Neurologic Complications and Neuromonitoring on ECMO

“…Changes in cerebral blood flow rate and volume can contribute to altered cerebral oxygenation as demonstrated by cerebral oximetry [12]. Impairments in cerebral autoregulation, based on wavelet transform coherence, are associated with findings on neuroimaging and neurologic outcomes [16].…”