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Association Between Disrupted Cerebral Autoregulation and Radiographic Neurologic Injury for Children on
Ethan L Sanford1,2, Rufai Akorede1, Isabel Miller3
1From the Department of Anesthesiology and Pain Management, UT Southwestern Medical Center/Children's Medical Center, Dallas, Texas.
ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|May 12, 2023
Summary
A new study shows that monitoring cerebral blood flow using diffuse correlation spectroscopy (DCS) can help detect neurologic injury in children on extracorporeal membrane oxygenation (ECMO). Disrupted cerebral autoregulation, measured by DCSx, is linked to higher injury scores.
Area of Science:
- Neuroscience
- Biomedical Engineering
- Pediatric Critical Care
Background:
- Neurologic injury is a significant risk for children on extracorporeal membrane oxygenation (ECMO).
- Early detection and prevention of neurologic injury are crucial for improving patient outcomes.
- Current monitoring methods for cerebral health during ECMO have limitations.
Purpose of the Study:
- To validate a real-time monitoring device for assessing neurologic injury risk in pediatric ECMO patients.
- To analyze the association between cerebral blood pressure autoregulation measured by diffuse correlation spectroscopy (DCS) and radiographic neurologic injury.
- To establish the feasibility of noninvasive DCS measurements in this patient population.
Main Methods:
- A pilot prospective cohort study involving children under 18 years old on ECMO.
- Regional cerebral blood flow measured using diffuse correlation spectroscopy (DCS).
- Cerebral autoregulation metric (DCSx) calculated by correlating DCS measurements with mean arterial blood pressure.
- Radiographic neurologic injury assessed via CT or MRI by a blinded pediatric neuroradiologist.
Main Results:
- Higher DCSx scores, indicating disrupted cerebral autoregulation, were associated with higher radiographic neurologic injury scores (slope, 11.0; 95% CI, 0.29-22).
- Patients with clinically significant neurologic injury (scores ≥10) exhibited higher median DCSx measures compared to those with lower scores (0.48 vs. 0.13; p = 0.01).
- Noninvasive DCS measurements were feasible in pediatric ECMO patients.
Conclusions:
- Disruption of cerebral autoregulation, as determined by DCS, is associated with increased radiographic neurologic injury in children on ECMO.
- Real-time DCS monitoring offers a potential tool for early detection and management of neurologic injury.
- This study supports the use of DCS for noninvasive assessment of cerebral health in critically ill children.
