Abstract
Neurological monitoring during ECMO is one of the most challenging tasks in an intensive care unit because of the complexity of the clinical scenario and the instability of the patient, who is most often in a comatose condition just before the onset of extracorporeal circulation. Neuromonitoring is an extension of clinical examination that is often unfeasible because of multi-organ failure, sedation, and hypothermic treatment. A multimodal neurophysiological strategy can overcome this limitation and provide additional information on brain function, blood-flow velocity, and brain oxygenation.
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References
Zanatta P, Messerotti Benvenuti S, Bosco E, Baldanzi F, Palomba D, Valfrè C (2011) Multimodal brain monitoring reduces major neurologic complications in cardiac surgery. J Cardiothorac Vasc Anesth 25(6):1076–1085
Edmonds HL Jr (2002) Multimodality neurophysiologic monitoring for cardiac surgery. Heart Surg Forum 5:225–228
Luyt CE, Landivier A, Leprince P, Bernard M, Pavie A, Chastre J, Combes A (2012) Usefulness of cardiac biomarkers to predict cardiac recovery in patients on extracorporeal membrane oxygenation support for refractory cardiogenic shock. J Crit Care 27(5):524.e7–524.e14
Sundt TH Jr, Sharbrough FW, Plepgras DG et al (1981) Correlation of cerebral blood flow and electroencephalographic changes during carotid endarterectomy with results of surgery and hemodynamics of cerebral ischemia. Mayo Clin Proc 56:533–543
Florence G, Guerit JM, Gueguen B (2004) Electroencephalography and somatosensory evoked potentials to prevent cerebral ischemia in the operating room. Neurophysiol Clin 34:17–32
Prior PF (1985) EEG monitoring and evoked potentials in brain ischemia. Br J Anaesth 57:63–81
Astrup J (1982) Energy requiring cell functions in the ischemic brain. J Neurosurg 56:482
de Vries JW, Bakker PF, Visser GH, Diephuis JC, van Huffelen AC (1998) Changes in cerebral oxygen uptake and cerebral electrical activity during defibrillation threshold testing. Anesth Analg 87(1):16–20
McGrail KM (1996) Intraoperative use of electroencephalography as an assessment of cerebral blood flow. Neurosurg Clin N Am 7(4):685–692, Review
Cloostermans MC, van Meulen FB, Eertman CJ, Hom HW, van Putten MJ (2012) Continuous electroencephalography monitoring for early prediction of neurological outcome in postanoxic patients after cardiac arrest: a prospective cohort study. Crit Care Med 40(10):2867–2875
Isley MR, Edmonds HL Jr, Stecker M, American Society of Neurophysiological Monitoring (2009) Guidelines for intraoperative neuromonitoring using raw (analog or digital waveforms) and quantitative electroencephalography: a position statement by the American Society of Neurophysiological Monitoring. J Clin Monit Comput 23(6):369–390
Horsch S, De Vleeschauwer P, Ktenidis K (1990) Intraoperative assessment of cerebral ischemia during carotid surgery. J Cardiovasc Surg 31:599–602
Prior P (1996) The rationale and utility of neurophysiological investigations in clinical monitoring for brain and spinal cord ischaemia during surgery and intensive care. Comput Methods Programs Biomed 51(1–2):13–27, Review
Guerit JM, Witdoeckt C, de Tourtchaninoff M et al (1997) Somatosensory evoked potential monitoring in carotid surgery. I. Relationships between qualitative sep alterations and intraoperative events. Electroencephalogr Clin Neurophysiol 104:459–469
Thiel A, Russ W, Zeiler D et al (1990) Transcranial Doppler sonography and somatosensory evoked potential monitoring in carotid surgery. Eur J Vasc Surg 4:597–602
Kochs E (1995) Electrophysiological monitoring and mild hypothermia. J Neurosurg Anesthesiol 7:222–228
Stecker MM, Cheung AT, Pochettino A, Kent GP, Patterson T, Weiss SJ, Bavaria JE (2001) Deep hypothermic circulatory arrest: I. Effects of cooling on electroencephalogram and evoked potentials. Ann Thorac Surg 71(1):14–21
Robinson LR, Micklesen PJ, Tirschwell DL, Lew HL (2003) Predictive value of somatosensory evoked potentials for awakening from coma. Crit Care Med 31:960–967
Oddo M, Rossetti AO (2011) Predicting neurological outcome after cardiac arrest. Curr Opin Crit Care 17(3):254–259
Daltrozzo J, Wioland N, Mutschler V, Kotchoubey B (2007) Predicting coma and other low responsive patients outcome using event-related brain potentials: a meta-analysis. Clin Neurophysiol 118:606–614
Zhang Y, Su YY, Ye H, Xiao SY, Chen WB, Zhao JW (2011) Predicting comatose patients with acute stroke outcome using middle-latency somatosensory evoked potentials. Clin Neurophysiol 122:1645–1649
Zanatta P, Messerotti Benvenuti S, Bosco E, Baldanzi F, Longo C, Palomba D, Salandin V, Sorbara C (2011) Intraoperative neurophysiological monitoring of the afferent pain pathway in cardiac surgery patients. Clin Neurophysiol 122:2093–2099
Madl C, Kramer L, Domanovits H, Woolard RH, Gervais H, Gendo A, Eisenhuber E, Grimm G, Sterz F (2000) Improved outcome prediction in unconscious cardiac arrest survivors with sensory evoked potentials compared with clinical assessment. Crit Care Med 28(3):721–726
Farag E, Abd-Elsayed A, Manno EM (2012) Sensory evoked potentials and the search for the Holy Grail method to predict the outcome after hypoxic-ischemic coma. Minerva Anestesiol 78(7):741–742
Bosco E, Marton E, Feletti A, Scarpa B, Longatti P, Zanatta P, Giorgi E, Sorbara C (2011) Dynamic monitors of brain function: a new target in neurointensive care unit. Crit Care 15(4):R170
Newell DW, Aaslid R (1992) Transcranial Doppler clinical and experimental uses. Cerebrovasc Brain Metab Rev 4:122–143
Burrows FA (1993) Transcranial Doppler monitoring of cerebral perfusion during cardiopulmonary bypass. Ann Thorac Surg 56:1482–1484
Zanatta P, Forti A, Bosco E, Salvador L, Borsato M, Baldanzi F, Longo C, Sorbara C, Longatti P, Valfrè C (2010) Microembolic signals and strategy to prevent gas embolism during extracorporeal membrane oxygenation. J Cardiothorac Surg 5:5
Zanatta P, Forti A, Minniti G, Comin A, Mazzarolo AP, Chilufya M, Baldanzi F, Bosco E, Sorbara C, Polesel E (2013) Brain emboli distribution and differentiation during cardiopulmonary bypass. J Cardiothorac Vasc Anesth 27(5):865–875
Cui W, Kumar C, Chance B (1991) Experimental study of migration depth for the photons measured at sample surface. Proc SPIE 1431:180–191
Edmonds HL (2005) Multimodality neuromonitoring for perioperative brain protection. Semin Anesth Perioper Med Pain 24:186–194
Daubeney PEF, Pilkington SN, Janke E et al (1996) Cerebral oxygenation measured by near-infrared spectroscopy: comparison with jugular bulb oximetry. Ann Thorac Surg 61:930–934
Yao FF, Chia-Chih A (2004) Cerebral oxygen desaturation is associated with early postoperative neuropsychological dysfunction in patients undergoing cardiac surgery. J Cardiothorac Vasc Anesth 18(5):552–558
Kadoi Y, Saito S, Goto F et al (2001) Decrease in jugular venous oxygen saturation during normothermic cardiopulmonary bypass predicts short-term postoperative neurologic dysfunction in elderly patients. J Am Coll Cardiol 38(5):1450–1455
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Zanatta, P., Bosco, E., Forti, A., Polesel, E., Sorbara, C. (2014). Neurological Monitoring During ECMO. In: Sangalli, F., Patroniti, N., Pesenti, A. (eds) ECMO-Extracorporeal Life Support in Adults. Springer, Milano. https://doi.org/10.1007/978-88-470-5427-1_34
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DOI: https://doi.org/10.1007/978-88-470-5427-1_34
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