Cerebral microemboli during extracorporeal life support: a single-centre cohort study

Area of Science:

• Cardiovascular Medicine
• Neurology
• Critical Care Medicine

Background:

• Venoarterial extracorporeal life support (ECLS) is a life-saving therapy for patients with severe circulatory failure.
• Cerebral microemboli are a potential complication of ECLS, but their load and composition are not well understood.
• Understanding cerebral microemboli in ECLS patients is crucial for mitigating neurological risks.

Purpose of the Study:

• To investigate the quantity and type of cerebral microemboli in adult patients undergoing venoarterial ECLS.
• To compare cerebral microemboli load in ECLS patients with critically ill controls and healthy volunteers.
• To evaluate the association between cerebral microemboli and neurological outcomes in ECLS patients.

Main Methods:

• Adult ECLS patients, critically ill controls, and healthy volunteers were enrolled.
• Cerebral microemboli were detected in the middle cerebral arteries using transcranial Doppler ultrasound for 30 minutes.
• Neurological outcomes were assessed, including ischemic stroke, global brain ischemia, and other neurological complications.

Main Results:

• ECLS patients exhibited significantly higher cerebral microemboli counts than both control groups (P < 0.023).
• Approximately 96.5% of microemboli in ECLS patients were gaseous; solid microemboli were infrequent.
• ECLS patients experienced more neurological complications than controls (12/20 vs 3/20, P = 0.003).

Conclusions:

• Adult ECLS patients face continuous exposure to numerous gaseous and occasional solid cerebral microemboli.
• The persistent formation of cerebral microemboli during ECLS may be a contributing factor to neurological complications.
• Further research is warranted to develop strategies for reducing microembolic burden and improving neurological outcomes in ECLS patients.