Challenges of acute phase neuroimaging in VA-ECMO, pitfalls and alternative imaging options

Area of Science:

• Neurology
• Cardiovascular Medicine
• Medical Imaging

Background:

• Clinical assessment of large vessel occlusion in patients on extracorporeal membrane oxygenation (ECMO) is limited by sedation and paralysis.
• Neurovascular imaging is crucial for diagnosing large vessel occlusion in ECMO patients.
• Computed tomography angiography (CTA) and computed tomography perfusion (CTP) are unreliable in ECMO due to altered hemodynamics.

Purpose of the Study:

• To review the utility of diagnostic imaging modalities for evaluating large vessel occlusion in patients undergoing VA-ECMO.
• To discuss the effectiveness of digital subtraction angiography (DSA) and transcranial doppler (TCD) in assessing ECMO-related hemodynamic changes and vascular patency.

Main Methods:

• Literature review of studies evaluating neurovascular imaging in ECMO patients.
• Analysis of the impact of ECMO circuitry on hemodynamic parameters and imaging accuracy.
• Discussion of the role of DSA in assessing vascular patency and altered hemodynamics.
• Exploration of the potential application of TCD in ECMO patients.

Main Results:

• Emergent CTA and CTP are inaccurate and unreliable in ECMO patients.
• DSA is a valuable tool for evaluating altered hemodynamics in VA-ECMO circuits.
• DSA can assess the patency of major vasculature in ECMO patients.
• TCD may have potential utility in monitoring ECMO patients.

Conclusions:

• DSA is a reliable method for assessing large vessel occlusion and hemodynamics in ECMO patients.
• TCD presents a potential non-invasive alternative for monitoring ECMO patients.
• Accurate neurovascular imaging is essential for managing ECMO patients with suspected large vessel occlusion.