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Using Quantitative EEG to Manage Blood Pressure in a Child With Carotid ECMO Cannulation: Case Report and Proof of
Natalie Pierson1,2, Natalia Lopez1,2, Yi Li3
1Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA.
Insights
Electroencephalography (EEG) can detect insufficient brain perfusion during pediatric extracorporeal membrane oxygenation (ECMO) with right common carotid artery cannulation. This may help prevent arterial ischemic stroke (AIS) in critically ill children.
Area of Science:
- Pediatric critical care medicine
- Neuroscience
- Cardiovascular surgery
Background:
- Pediatric extracorporeal membrane oxygenation (ECMO) is associated with a high risk of arterial ischemic stroke (AIS).
- Right common carotid artery (RCCA) cannulation during ECMO may lead to AIS due to inadequate cross-lateral cerebral perfusion, especially during hypotension.
- Identifying mechanisms of AIS in this population is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate the utility of electroencephalography (EEG) in identifying insufficient cross-lateral cerebral perfusion in a pediatric patient undergoing ECMO with RCCA cannulation.
- To explore the relationship between hemodynamic status and cerebral perfusion as indicated by EEG.
Main Methods:
- Case report of a 2-year-old patient on ECMO with RCCA cannulation.
- Time-synchronized quantitative EEG and invasive blood pressure monitoring were utilized.
- Neuroimaging was performed before and after ECMO decannulation.
Main Results:
- The patient exhibited EEG evidence of right hemispheric ischemia but survived ECMO with minimal neurologic deficits and no cortical infarct.
- Post-decannulation neuroimaging revealed transient right carotid artery narrowing.
- A weak correlation (r² = 0.18) was found between blood pressure and EEG asymmetry, suggesting covariant fluctuations.
Conclusions:
- EEG can serve as a valuable tool for detecting insufficient cross-lateral cerebral perfusion in pediatric ECMO patients with RCCA cannulation.
- This finding supports the hypothesis that inadequate perfusion is a potential mechanism for AIS in this context.
- Further research is warranted to optimize EEG-guided hemodynamic management strategies for these high-risk patients.
Abstract:
Pediatric extracorporeal membrane oxygenation (ECMO) carries a high risk of arterial ischemic stroke (AIS). AIS in patients with right common carotid artery (RCCA) cannulation may be driven by inadequate cross-lateral perfusion from the left hemisphere during hypotensive episodes. We present the case of a 2-year-old on ECMO with RCCA cannulation who had electroencephalographic (EEG) evidence of right hemispheric ischemia yet survived ECMO without cortical infarct and minimal neurologic deficits. Neuroimaging after decannulation showed right carotid narrowing that resolved after 2 weeks. Analysis of time-synchronized quantitative EEG metrics and invasive blood pressure monitoring showed a weak but present correlation (r2 = 0.18), indicating covariant fluctuation in blood pressure and EEG asymmetry. This report affirms EEG as a tool to identify insufficient cross-lateral cerebral perfusion with RCCA cannulation as a potential mechanism of AIS pathogenesis in ECMO. Further research is needed to optimize EEG-guided hemodynamic management in patients with RCCA cannulation.
