Ch 28 (s28.6, s28.8, s28.9, s28.10, s28.12, s28.14)
The source of the framing statement that there is no established neuromonitoring protocol on ECMO, and of the physiological detail needed to read a near-infrared spectroscopy or transcranial Doppler trace correctly — particularly that the sampling volume is small, superficial and frontal, so posterior or deep lesions are invisible.
Not applicable
DOI 10.1155/2018/3237810
Review of near-infrared spectroscopy, transcranial Doppler, electroencephalography, evoked potentials, optic nerve sheath diameter, diffuse correlation spectroscopy and serum biomarkers
Narrative review; the transcranial Doppler figures are single-centre descriptive values, not normal ranges; the seizure range is wide and conditioned on who was recorded. The article was returned in the search record under both a plain digital object identifier and a compound form with identical text; the plain form is cited.
States that the optimal neuromonitoring protocol has not been well established, with current practices dependent on physician preference or device availability. Near-infrared light penetrates 2 to 2.5 cm, with regional saturation a surrogate for cerebral blood flow and the cerebral oximetry index approaching 1 indicating pressure-passive flow. Transcranial Doppler pulsatility index is lower during ECMO initiation; rising pulsatility may indicate cerebral pathology; the centre's own figures show low mean middle cerebral artery velocities with normal pulsatility index on venovenous and low pulsatility index on venoarterial support. Magnetic resonance imaging cannot be used while on ECMO due to hardware incompatibility. Electroencephalogram abnormal in 50 to 80 percent of ECMO patients with electrographic seizures reported at 8 to 20 percent; continuous recording is a scarce resource so many institutions check periodic 20-minute to 1-hour studies. Biomarkers GFAP, S100b, neuron-specific enolase, ICAM5, BDNF and MCP-1/CCL2 are candidates with debate over optimal cut-offs and whether serial assessment adds meaning.
Adults on venovenous and venoarterial ECMO; narrative review with single-centre descriptive observations