Multimodal Neurologic Monitoring in Patients Undergoing Extracorporeal Membrane Oxygenation

Area of Science:

• Neurology
• Critical Care Medicine
• Medical Technology

Background:

• Extracorporeal membrane oxygenation (ECMO) is linked to significant neurologic complications.
• Early detection and intervention of neurologic issues during ECMO are crucial.
• Multimodal neurologic monitoring (MNM) offers a potential solution for proactive neurologic assessment.

Purpose of the Study:

• To evaluate the safety and feasibility of noninvasive MNM in patients undergoing ECMO.
• To identify differences in transcranial Doppler (TCD) sonography and electroencephalography (EEG) characteristics between survivors and non-survivors.
• To investigate adverse neurologic events and their association with EEG and TCD findings in different ECMO types.

Main Methods:

• An observational study was conducted on patients receiving ECMO from January 2017 to February 2019.
• All patients underwent a noninvasive MNM protocol, including EEG and TCD.
• Data were analyzed to compare neurologic monitoring findings based on survival, ECMO type, and adverse events.

Main Results:

• MNM was safely completed in 75% of patients, with no adverse events, demonstrating feasibility.
• Non-survivors were older, had lower ejection fractions, and showed lower TCD pulsatility and resistivity indexes.
• Adverse neurologic events (24.7%), including stroke and hemorrhage, occurred primarily in venoarterial (VA)-ECMO patients, who also had distinct EEG patterns.

Conclusions:

• Noninvasive MNM is a safe and feasible approach for patients on ECMO.
• Specific EEG and TCD findings can assist in early detection of neurologic deterioration.
• MNM shows promise for monitoring, prognostication, and clinical decision-making in ECMO patients.