Ch 28 (s28.8, s28.11, s28.16); Ch 23
A present N20 carries very little reassurance on ECMO — in the only series that looked, it was intact in every patient who did badly. And the two electrophysiological tests disagreed in more than half the patients in whom both were done, so they cannot be summed into a single 'electrophysiology' impression, which makes the multimodal rule of 'at least two indicators of severe injury' much harder to apply.
Favourable (modified Rankin Scale 0 to 3) versus unfavourable (over 3) outcome at discharge
DOI 10.1097/MAT.0000000000001013
Noninvasive multimodal neuromonitoring — neurological examinations, transcranial Doppler, electroencephalography and somatosensory evoked potentials at prespecified intervals
Twenty patients, seven with paired electrophysiology; single centre; the microembolic finding is directly contradicted by the same group's larger 145-patient cohort (Caturegli 2022).
Neurological complications found in 17 of 20 (85 percent); unfavourable outcome in 14 (70 percent), associated with absent electroencephalographic reactivity, coma, central cannulation, higher transfusion requirement and higher APACHE II and SOFA scores. Eighteen thromboembolic events observed, 14 with positive microembolic signals; all 10 patients with arterial-sided thrombotic events had positive signals. Of the 7 patients with both evoked potentials and electroencephalography, ALL 7 had intact N20 responses despite poor outcomes, and 4 of those 7 showed absent electroencephalographic reactivity despite the intact N20. No adverse effects from monitoring.
20 adult ECMO patients (median age 60) at a single centre: 17 had transcranial Doppler, 13 electroencephalography and 7 somatosensory evoked potentials