Transcranial Doppler Changes in Patients Treated with Extracorporeal Membrane Oxygenation

Kavi, Tapan; Esch, Megan; Rinsky, Brenda; Rosengart, Axel J.; Lahiri, Shouri; Lyden, Patrick D.

doi:10.1016/j.jstrokecerebrovasdis.2016.07.050

Cited by 22 publications

(23 citation statements)

References 7 publications

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“…In a study where modified apnea testing was applied successfully; the patient was taking triple inotrope and although the apnea testing was completed, hemodynamic changes or arrhythmias were not noted during or after the testing [10]. Like the apnea testing, reliability of biomarkers such as BIS, transcranial Doppler, or glial fibrillary acidic protein (GFAP) was not fully established [13][14][15]. Absence of cerebral circulation is important for the diagnosis of brain death.…”

Section: Discussionmentioning

confidence: 99%

An approach to diagnosing brain death in patients undergoing extracorporeal membrane oxygenation

Altınsoy

Akkuş

Çatalca

et al. 2020

The European Research Journal

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Objectives:This study was intended to discuss the process of brain death diagnosis of patients undergoing extracorporeal membrane oxygenation (ECMO) and our approach regarding the existing literature. Methods: Demographics data (age, gender, admission diagnosis) were noted. ECMO type applied (venovenous or veno-arterial), time of diagnosing brain death (the time from admission time till diagnosis), being a donor or not, apnea testing application, supplementary tests applied at diagnosis stage (cerebral angiography, computerized tomography angiography, electroencephalography, transcranial doppler ultrasonography), and time of cardiac death (the time elapsing from the moment of brain death diagnosis till cardiac arrest) were noted. Results: Forty-two patients data were exaimed and ECMO was applied to 8 patients, 4 of whom are female and the others are male. The average age of the patients is 61.8 ± 9.8 years. The average time elapsing from the hospitalization till brain death diagnosis was 2.5 ± 0.5 days. Apart from that, only 2 (25%) of the patients were donors. Conclusions: The use of modified apnea testing on patients undergoing ECMO could be proliferated if such tests are standardized and reliable guidelines are set. For this reason, we think that cerebral angiography should be kept in mind in addition to apnea test especially on ECMO-treated patients.

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Section: Discussionmentioning

confidence: 99%

An approach to diagnosing brain death in patients undergoing extracorporeal membrane oxygenation

Altınsoy

Akkuş

Çatalca

et al. 2020

The European Research Journal

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“…104 Regarding TCD in low flow states, such as cardiogenic shock or cardiac arrest treated with ECMO, it has been shown that an ejection fraction of less than 10% can give rise to a nonpulsatile TCD waveform: in these cases, a low PI or lack of systolic upstroke may not be related to cerebral vasodilation; also, rising of the PI could result from an improving ejection fraction and not increasing ICP. 105 There are no reliable data regarding the goal of TCD parameters to optimize cerebral blood flow based on ECMO flow. 106…”

Section: Transcranial Dopplermentioning

confidence: 99%

Brain Injury in Extracorporeal Membrane Oxygenation: A Multidisciplinary Approach

et al. 2021

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Extracorporeal membrane oxygenation (ECMO) represents an established technique to provide temporary cardiac and/or pulmonary support. ECMO, in veno-venous, veno-arterial or in extracorporeal carbon dioxide removal modality, is associated with a high rate of brain injuries. These complications have been reported in 7 to 15% of adults and 20% of neonates, and are associated with poor survival. Thromboembolic events, loss of cerebral autoregulation, alteration of the blood–brain barrier, and hemorrhage related to anticoagulation represent the main causes of severe brain injury during ECMO. The most frequent forms of acute neurological injuries in ECMO patients are intracranial hemorrhage (2–21%), ischemic stroke (2–10%), seizures (2–6%), and hypoxic–ischemic brain injury; brain death may also occur in this population. Other frequent complications are infarction (1–8%) and cerebral edema (2–10%), as well as neuropsychological and psychiatric sequelae, including posttraumatic stress disorder.

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“…116 TCD to diagnose cerebral circulatory arrest has been reviewed and is limited to patients with pulsatility. 117,118 In neonates, TCD is more useful for detecting intracranial hemorrhage than cerebral ischemia.…”

Section: Neurologic Injury and Ecmomentioning

confidence: 99%

Extracorporeal Membrane Oxygenation: The New Jack-of-All-Trades?

Kwak

Majewski

Jellish

2020

Journal of Cardiothoracic and Vascular Anesthesia

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Transcranial Doppler Changes in Patients Treated with Extracorporeal Membrane Oxygenation

Cited by 22 publications

References 7 publications

An approach to diagnosing brain death in patients undergoing extracorporeal membrane oxygenation

An approach to diagnosing brain death in patients undergoing extracorporeal membrane oxygenation

Brain Injury in Extracorporeal Membrane Oxygenation: A Multidisciplinary Approach

Extracorporeal Membrane Oxygenation: The New Jack-of-All-Trades?

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