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Noninvasive Neurological Monitoring in Extracorporeal Membrane Oxygenation

Cho, Sung-Min*; Ziai, Wendy*; Mayasi, Yunis*; Gusdon, Aaron M.*; Creed, Jennifer*; Sharrock, Matthew*; Stephens, Robert Scott; Choi, Chun Woo; Ritzl, Eva K.*; Suarez, Jose*; Whitman, Glenn; Geocadin, Romergryko G.*

doi: 10.1097/MAT.0000000000001013
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Optimal neurologic monitoring methods have not been characterized for patients on extracorporeal membrane oxygenation (ECMO). We assessed the feasibility of noninvasive multimodal neuromonitoring (NMN) to prognosticate outcome. In this prospective observational study, neurologic examinations, transcranial Doppler (TCD), electroencephalography (EEG), and somatosensory evoked potentials (SSEPs) were performed at prespecified intervals. Outcome at discharge was defined as favorable when modified Rankin Scale (mRS) 0–3; unfavorable when mRS >3. Of 20 patients (median age 60 years), 17 had TCDs, 13 had EEGs, and seven had SSEPs. With NMN, 17 (85%) were found to have neurologic complications. Fourteen (70%) had unfavorable outcomes. The unfavorable outcome was associated with absent EEG reactivity, coma, central cannulation, higher transfusion requirement, and higher Acute Physiology and Chronic Health Evaluation II and Sepsis-related Organ Failure Assessment scores. Seven patients had both SSEPs and EEGs and exhibited intact N20 responses despite poor outcomes. Four of these seven showed absent EEG reactivity despite intact N20. Eighteen thromboembolic events were observed, 14 of which had positive microembolic signals (MESs) in TCD. All 10 patients with arterial-sided thrombotic events had positive MES. NMN caused no adverse effects. NMN during ECMO is feasible and found high neurologic complication rate. EEG and TCD showed potential for prognostication of neurologic outcome.

*Neurosciences Critical Care, Departments of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland;

Medical Intensive Care, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; and

Cardiovascular Surgical Intensive Care, Heart and Vascular Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Submitted for consideration January 2019; accepted for publication in revised form March 2019.

Disclosure: The authors have no conflicts of interest to report.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (www.asaiojournal.com).

Correspondence: Sung-Min Cho, Department of Anesthesiology and Critical Care Medicine, Neurocritical Care Division, Johns Hopkins Medical Institutions, 600 N. Wolfe Street, Phipps 455, Baltimore, MD 21287. Email: csmfisher@gmail.com.

Copyright © 2019 by the American Society for Artificial Internal Organs