Neurocritical Care for Extracorporeal Membrane Oxygenation Patients

Sung-Min Cho, DO; Salia Farrokh, PharmD; Glenn Whitman, MD; Thomas P. Bleck, MD; Romergryko G. Geocadin, MD

Disclosures

Crit Care Med. 2019;47(12):1773-1781. 

In This Article

Abstract and Introduction

Abstract

Objectives: To review the neurocritical care aspects of patients supported by extracorporeal membrane oxygenation, including cerebral physiology, neurologic monitoring, use of sedatives and anti-seizure medications, and prevalence and management of extracorporeal membrane oxygenation associated brain injury.

Data Sources: PubMed database search using relevant search terms related to neurologic complications, neurocritical care management, and brain injury management in patients with extracorporeal membrane oxygenation.

Study Selection: Articles included original investigations, review articles, consensus statements and guidelines.

Data Extraction: A detailed review of publications performed and relevant publications were summarized.

Data Synthesis: We found no practice guidelines or management strategies for the neurocritical care of extracorporeal membrane oxygenation patients. Such patients are at high risk for hypoxic-ischemic brain injury, intracranial hemorrhage, cerebral edema, and brain death. Improving clinical outcomes will depend on better defining the neurologic complications and underlying pathophysiology that are specific to extracorporeal membrane oxygenation. Currently, insufficient understanding of the pathophysiology of neurologic complications prevents us from addressing their etiologies with specific, targeted monitoring techniques and interventions.

Conclusions: A large knowledge gap exists in our understanding and treatment of extracorporeal membrane oxygenation-related neurologic complications. A systematic and multidisciplinary approach is needed to reduce the prevalence of these complications and to better manage the neurologic sequelae of extracorporeal membrane oxygenation in a way that will improve patient outcomes.

Introduction

Extracorporeal membrane oxygenation (ECMO) provides temporary emergency cardiopulmonary and circulatory support to patients with acute respiratory or cardiac failure that is refractory to all other conventional therapies.[1] Commonly, venoarterial and venovenous ECMO are used for acute cardiac and respiratory failure, respectively. The use of ECMO has increased more than 10-fold in adults with profound cardiopulmonary failure or cardiac arrest over the last decade.[2] Furthermore, the Extracorporeal Life Support Organization (ELSO) registry recently reported that survival after ECMO had increased to 58% from an abysmal rate 20–30 years ago.[3] Frequently, mortality and poor functional outcomes are driven by neurologic injury that results not only from the underlying disease process but also from complications associated with ECMO support itself.[4,5] As ECMO becomes more widely used and clinical experience accumulates, management of ECMO-associated neurologic injuries is imperative.

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