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Published on: October 24, 2018
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.
Insights
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.
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.
Abstract:
Extracorporeal membrane oxygenation is a potentially lifesaving intervention for children with severe cardiac or respiratory failure. It is used with increasing frequency and in increasingly more complex and severe diseases. Neurological injuries are important causes of morbidity and mortality in children treated with extracorporeal membrane oxygenation and include ischemic stroke, intracranial hemorrhage, hypoxic-ischemic injury, and seizures. In this review, we discuss the epidemiology and pathophysiology of neurological injury in patients supported with extracorporeal membrane oxygenation, and we review the current state of knowledge for available modalities of monitoring neurological function in these children. These include structural imaging with computed tomography and ultrasound, cerebral blood flow monitoring with near-infrared spectroscopy and transcranial Doppler ultrasound, and physiological monitoring with electroencephalography and plasma biomarkers. We highlight areas of need and emerging advances that will improve our understanding of neurological injury related to extracorporeal membrane oxygenation and help to reduce the burden of neurological sequelae in these children.
