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Related Concept Videos

Pulse rhythm01:30

Pulse rhythm

882
Pulse rhythm refers to the pattern of pulsations within specific intervals, offering valuable insights into the regularity or irregularity of the heart's beats as observed through the pattern of pulsation within specific intervals. A regular pulse exhibits a consistent heart rate with uniform waveforms and pulsation force, variations of which can be classified as normal, weak, or bounding.
Conversely, an irregular pulse pattern is termed dysrhythmia, stemming from disruptions in cardiac...
882

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Neuromonitoring During ECMO Support in Children.

Ryan J Felling1, Asavari Kamerkar2, Matthew L Friedman3

  • 1Department of Neurology, Johns Hopkins University School of Medicine, 200 N. Wolfe Street, Suite 2158, Baltimore, MD, USA. rfelling@jhmi.edu.

Neurocritical Care
|January 31, 2023
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Summary

Extracorporeal membrane oxygenation (ECMO) can save children with severe heart or lung failure. This review covers neurological injuries during ECMO and discusses current monitoring methods to reduce harm.

Keywords:
BiomarkersElectroencephalographyExtracorporeal membrane oxygenationIntracranial hemorrhageNeuroimagingSeizuresStrokeTranscranial doppler

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Area of Science:

  • Pediatric critical care medicine
  • Neurocritical care
  • Cardiopulmonary support

Background:

  • Extracorporeal membrane oxygenation (ECMO) is a vital treatment for pediatric patients with severe cardiac or respiratory failure.
  • Neurological injuries, including stroke, hemorrhage, and hypoxic-ischemic injury, are significant complications in children undergoing ECMO.
  • Increasing use of ECMO in complex pediatric diseases necessitates a thorough understanding of associated neurological risks.

Purpose of the Study:

  • To review the epidemiology and pathophysiology of neurological injury in pediatric ECMO patients.
  • To evaluate current modalities for monitoring neurological function in children on ECMO.
  • To identify knowledge gaps and emerging advances in managing ECMO-related neurological complications.

Main Methods:

  • Review of existing literature on neurological injury and monitoring in pediatric ECMO.
  • Discussion of structural imaging techniques: computed tomography (CT) and ultrasound.
  • Analysis of cerebral blood flow monitoring: near-infrared spectroscopy (NIRS) and transcranial Doppler (TCD) ultrasound.
  • Evaluation of physiological monitoring: electroencephalography (EEG) and plasma biomarkers.

Main Results:

  • Neurological injuries are common and contribute to morbidity and mortality in pediatric ECMO patients.
  • Current monitoring includes structural imaging, cerebral blood flow assessment, and physiological monitoring.
  • Each monitoring modality has limitations, highlighting the need for improved diagnostic and prognostic tools.

Conclusions:

  • Understanding the mechanisms of neurological injury during ECMO is crucial for prevention and management.
  • Multimodal neuromonitoring strategies are essential for early detection and intervention in pediatric ECMO.
  • Further research and technological advancements are needed to minimize neurological sequelae in this vulnerable population.