Ch 28 (s28.4)
The pre-cannulation examination is often the only unsedated examination that will exist for days and must be recorded, or its absence explicitly charted. Charting an unobtainable examination as normal creates a false baseline and removes the prompt to obtain a real one.
Serial bedside examination remains the mainstay of neurological assessment in ECMO patients. A baseline neurological assessment is recommended before and immediately after cannulation, followed by serial evaluations throughout support and after weaning. Ideal frequency is not established; daily assessment by a neurologist or neurointensivist can improve care, and nursing assessment every 1 to 4 hours stratified by brain-injury risk is reasonable. Examination should include mental status, brainstem reflexes (pupillary light response, oculocephalic, corneal, cough and gag) and motor examination, using the Glasgow Coma Scale and Confusion Assessment Method. Motor response is only helpful when analgosedation and paralytic are lightened or off; sensory examination is mostly limited; spinal cord injury examination is very challenging.
Neurological monitoring on adult ECMO