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Neurocritical Care for Extracorporeal Membrane Oxygenation Patients

Cho, Sung-Min DO1–3; Farrokh, Salia PharmD1–3; Whitman, Glenn MD4; Bleck, Thomas P. MD5; Geocadin, Romergryko G. MD1–3

doi: 10.1097/CCM.0000000000004060
Concise Definitive Review

Objectives: To review the neurocritical care aspects of patients supported by extracorporeal membrane oxygenation, including cerebral physiology, neurologic monitoring, use of sedatives and anti-seizure medications, and prevalence and management of extracorporeal membrane oxygenation associated brain injury.

Data Sources: PubMed database search using relevant search terms related to neurologic complications, neurocritical care management, and brain injury management in patients with extracorporeal membrane oxygenation.

Study Selection: Articles included original investigations, review articles, consensus statements and guidelines.

Data Extraction: A detailed review of publications performed and relevant publications were summarized.

Data Synthesis: We found no practice guidelines or management strategies for the neurocritical care of extracorporeal membrane oxygenation patients. Such patients are at high risk for hypoxic-ischemic brain injury, intracranial hemorrhage, cerebral edema, and brain death. Improving clinical outcomes will depend on better defining the neurologic complications and underlying pathophysiology that are specific to extracorporeal membrane oxygenation. Currently, insufficient understanding of the pathophysiology of neurologic complications prevents us from addressing their etiologies with specific, targeted monitoring techniques and interventions.

Conclusions: A large knowledge gap exists in our understanding and treatment of extracorporeal membrane oxygenation-related neurologic complications. A systematic and multidisciplinary approach is needed to reduce the prevalence of these complications and to better manage the neurologic sequelae of extracorporeal membrane oxygenation in a way that will improve patient outcomes.

1Neurosciences Critical Care, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD.

2Neurosciences Critical Care, Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD.

3Neurosciences Critical Care, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.

4Division of Cardiac Surgery, Cardiac Surgical Intensive Care, Johns Hopkins Medical Institution, Baltimore, MD.

5Neuro Critical Care, Northwestern University Feinberg School of Medicine, Chicago, IL.

Dr. Cho receives a grant from the Extracorporeal Life Support Organization. Dr. Geocadin received support for article research from the National Institutes of Health. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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