Ch 28 (s28.3, s28.14)
The solid finding is about detection, not outcome: a protocol roughly doubles the odds that brain injury is diagnosed, which is exactly what the detection-gap argument predicts. The 2024 ELSO consensus cites this literature in the careful form — that protocolised monitoring improves the DETECTION of acute brain injury — and that is the phrasing to repeat.
Era without standardised neuromonitoring
DOI 10.1016/j.jtcvs.2021.09.063
Protocolised noninvasive multimodal neuromonitoring — serial neurological examinations, electroencephalography, transcranial Doppler and somatosensory evoked potentials
Before-and-after comparison at one centre over a period in which much else changed, including the introduction of neurocritical care consultation, and during which ECMO outcomes improved secularly. The design cannot separate 'we found more injury and acted on it' from 'our programme matured'. Carries a 2021 online and a 2023 print publication year, reproduced as found.
Acute brain injury was diagnosed in 23 percent in era 1 and 33 percent in era 2 (p=0.12 unadjusted). On multivariable logistic regression, standardised neuromonitoring was independently associated with a diagnosis of acute brain injury (odds ratio 2.24, 95 percent CI 1.12 to 4.48, p=0.02), alongside pre-ECMO cardiac arrest (odds ratio 2.17, 1.14 to 4.14, p=0.02). A greater proportion of patients had good neurological outcome in era 2.
215 adult ECMO patients at a single institution (mean age 54, 60 percent male, 71 percent venoarterial) who received neurocritical care consultation, stratified by era: 70 in era 1 (2016 to 2017) without standardised neuromonitoring and 145 in era 2 (2017 to 2020) with it