Transcranial Doppler microemboli and acute brain injury in extracorporeal membrane oxygenation: A prospective observational studyCentral MessagePerspective
Objective: Extracorporeal membrane oxygenation (ECMO) carries a high morbidity of acute brain injury (ABI) with resultant mortality increase. Transcranial Doppler (TCD) allows real-time characterization of regional cerebral hemodynamics, but limited data exist on the interpretation of microembolic s...
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| Language: | English |
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Elsevier
2022-10-01
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| Series: | JTCVS Techniques |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666250722004473 |
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| author | Giorgio Caturegli, BS Shrey Kapoor, BS Vladimir Ponomarev, RVS Bo Soo Kim, MD Glenn J.R. Whitman, MD Wendy Ziai, MD, MPH Sung-Min Cho, DO, MHS Lucy Q. Zhang, MD Yunis Mayasi, MD Aaron Gusdon, MD Bahattin Ergin, RVT Steven Keller, MD Matthew Acton, MD Hannah Rando, MD Diane Alejo Kate Calligy, RN Scott Anderson Benjamin Shou, BS Pedro A. Mendez-Tellez, MD Henry Chang, MD, PhD Marc Sussman, MD Christopher Wilcox, DO, MS Patricia Brown, RD-AP, CNSC Anna Peeler, RN |
| author_facet | Giorgio Caturegli, BS Shrey Kapoor, BS Vladimir Ponomarev, RVS Bo Soo Kim, MD Glenn J.R. Whitman, MD Wendy Ziai, MD, MPH Sung-Min Cho, DO, MHS Lucy Q. Zhang, MD Yunis Mayasi, MD Aaron Gusdon, MD Bahattin Ergin, RVT Steven Keller, MD Matthew Acton, MD Hannah Rando, MD Diane Alejo Kate Calligy, RN Scott Anderson Benjamin Shou, BS Pedro A. Mendez-Tellez, MD Henry Chang, MD, PhD Marc Sussman, MD Christopher Wilcox, DO, MS Patricia Brown, RD-AP, CNSC Anna Peeler, RN |
| author_sort | Giorgio Caturegli, BS |
| collection | DOAJ |
| description | Objective: Extracorporeal membrane oxygenation (ECMO) carries a high morbidity of acute brain injury (ABI) with resultant mortality increase. Transcranial Doppler (TCD) allows real-time characterization of regional cerebral hemodynamics, but limited data exist on the interpretation of microembolic signals (MES) in ECMO. Methods: This prospective cohort study was conducted at a single tertiary care center, November 2017 through February 2022, and included all adult patients receiving venoarterial (VA) and venovenous (VV) ECMO undergoing TCD examinations, which all included MES monitoring. Results: Of 145 patients on ECMO who underwent at least 1 TCD examination, 100 (68.9%) patients on VA-ECMO received 187 examinations whereas 45 (31.1%) patients on VV-ECMO received 65 examinations (P = .81). MES were observed in 35 (35.0%) patients on VA-ECMO and 2 (4.7%) patients on VV-ECMO (P < .001), corresponding to 46 (24.6%) and 2 (3.1%) TCD examinations, respectively. MES were present in 29.4% of patients on VA-ECMO without additional cardiac support, compared with 38.1% with intra-aortic balloon pump and 57.1% with left ventricular assist device, but these differences were not statistically significant (P = .39; P = .20, respectively). Presence or number of MES was not associated with VA-ECMO cannulation mode (23.4% MES presence in peripheral cannulation vs 25.8% in central cannulation, P = .80). In both VA- and VV-ECMO, MES presence or number was not associated with presence of clot or fibrin in the ECMO circuit or with any studied hemodynamic, laboratory, or ECMO parameters at the time of TCD. ABI occurred in 38% and 31.1% of patients on VA- and VV-ECMO, respectively. In multivariable logistic regression analyses, neither ABI nor a composite outcome of arterial thromboembolic events was associated with presence or number of MES in VA- ECMO. Conclusions: TCD analysis in a large cohort of patients on ECMO demonstrates a significant number of MES, especially in patients on VA-ECMO with intra-aortic balloon pump, and/or left ventricular assist device. However, clinical associations and significance of TCD MES remain unresolved and warrant further correlation with systematic imaging and long-term neurologic follow-up. |
| format | Article |
| id | doaj-art-16fe904dceee4876bbb97cc270d974d5 |
| institution | Kabale University |
| issn | 2666-2507 |
| language | English |
| publishDate | 2022-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Techniques |
| spelling | doaj-art-16fe904dceee4876bbb97cc270d974d52025-08-20T03:38:23ZengElsevierJTCVS Techniques2666-25072022-10-011511112210.1016/j.xjtc.2022.07.026Transcranial Doppler microemboli and acute brain injury in extracorporeal membrane oxygenation: A prospective observational studyCentral MessagePerspectiveGiorgio Caturegli, BS0Shrey Kapoor, BS1Vladimir Ponomarev, RVS2Bo Soo Kim, MD3Glenn J.R. Whitman, MD4Wendy Ziai, MD, MPH5Sung-Min Cho, DO, MHS6Lucy Q. Zhang, MDYunis Mayasi, MDAaron Gusdon, MDBahattin Ergin, RVTSteven Keller, MDMatthew Acton, MDHannah Rando, MDDiane AlejoKate Calligy, RNScott AndersonBenjamin Shou, BSPedro A. Mendez-Tellez, MDHenry Chang, MD, PhDMarc Sussman, MDChristopher Wilcox, DO, MSPatricia Brown, RD-AP, CNSCAnna Peeler, RNDivision of Neurosciences Critical Care, Departments of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MdDivision of Neurosciences Critical Care, Departments of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MdDivision of Neurosciences Critical Care, Departments of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MdDivision of Pulmonary and Critical Care Medicine, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MdDivision of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MdDivision of Neurosciences Critical Care, Departments of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MdDivision of Neurosciences Critical Care, Departments of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Md; Address for reprints: Sung-Min Cho, DO, MHS, and Wendy Ziai, MD, MPH, Department of Anesthesiology and Critical Care Medicine, Neurocritical Care Division, Johns Hopkins Medical Institutions, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287.Objective: Extracorporeal membrane oxygenation (ECMO) carries a high morbidity of acute brain injury (ABI) with resultant mortality increase. Transcranial Doppler (TCD) allows real-time characterization of regional cerebral hemodynamics, but limited data exist on the interpretation of microembolic signals (MES) in ECMO. Methods: This prospective cohort study was conducted at a single tertiary care center, November 2017 through February 2022, and included all adult patients receiving venoarterial (VA) and venovenous (VV) ECMO undergoing TCD examinations, which all included MES monitoring. Results: Of 145 patients on ECMO who underwent at least 1 TCD examination, 100 (68.9%) patients on VA-ECMO received 187 examinations whereas 45 (31.1%) patients on VV-ECMO received 65 examinations (P = .81). MES were observed in 35 (35.0%) patients on VA-ECMO and 2 (4.7%) patients on VV-ECMO (P < .001), corresponding to 46 (24.6%) and 2 (3.1%) TCD examinations, respectively. MES were present in 29.4% of patients on VA-ECMO without additional cardiac support, compared with 38.1% with intra-aortic balloon pump and 57.1% with left ventricular assist device, but these differences were not statistically significant (P = .39; P = .20, respectively). Presence or number of MES was not associated with VA-ECMO cannulation mode (23.4% MES presence in peripheral cannulation vs 25.8% in central cannulation, P = .80). In both VA- and VV-ECMO, MES presence or number was not associated with presence of clot or fibrin in the ECMO circuit or with any studied hemodynamic, laboratory, or ECMO parameters at the time of TCD. ABI occurred in 38% and 31.1% of patients on VA- and VV-ECMO, respectively. In multivariable logistic regression analyses, neither ABI nor a composite outcome of arterial thromboembolic events was associated with presence or number of MES in VA- ECMO. Conclusions: TCD analysis in a large cohort of patients on ECMO demonstrates a significant number of MES, especially in patients on VA-ECMO with intra-aortic balloon pump, and/or left ventricular assist device. However, clinical associations and significance of TCD MES remain unresolved and warrant further correlation with systematic imaging and long-term neurologic follow-up.http://www.sciencedirect.com/science/article/pii/S2666250722004473ECMOextracorporeal membrane oxygenationTCDtranscranial Dopplerbrain injurystroke |
| spellingShingle | Giorgio Caturegli, BS Shrey Kapoor, BS Vladimir Ponomarev, RVS Bo Soo Kim, MD Glenn J.R. Whitman, MD Wendy Ziai, MD, MPH Sung-Min Cho, DO, MHS Lucy Q. Zhang, MD Yunis Mayasi, MD Aaron Gusdon, MD Bahattin Ergin, RVT Steven Keller, MD Matthew Acton, MD Hannah Rando, MD Diane Alejo Kate Calligy, RN Scott Anderson Benjamin Shou, BS Pedro A. Mendez-Tellez, MD Henry Chang, MD, PhD Marc Sussman, MD Christopher Wilcox, DO, MS Patricia Brown, RD-AP, CNSC Anna Peeler, RN Transcranial Doppler microemboli and acute brain injury in extracorporeal membrane oxygenation: A prospective observational studyCentral MessagePerspective JTCVS Techniques ECMO extracorporeal membrane oxygenation TCD transcranial Doppler brain injury stroke |
| title | Transcranial Doppler microemboli and acute brain injury in extracorporeal membrane oxygenation: A prospective observational studyCentral MessagePerspective |
| title_full | Transcranial Doppler microemboli and acute brain injury in extracorporeal membrane oxygenation: A prospective observational studyCentral MessagePerspective |
| title_fullStr | Transcranial Doppler microemboli and acute brain injury in extracorporeal membrane oxygenation: A prospective observational studyCentral MessagePerspective |
| title_full_unstemmed | Transcranial Doppler microemboli and acute brain injury in extracorporeal membrane oxygenation: A prospective observational studyCentral MessagePerspective |
| title_short | Transcranial Doppler microemboli and acute brain injury in extracorporeal membrane oxygenation: A prospective observational studyCentral MessagePerspective |
| title_sort | transcranial doppler microemboli and acute brain injury in extracorporeal membrane oxygenation a prospective observational studycentral messageperspective |
| topic | ECMO extracorporeal membrane oxygenation TCD transcranial Doppler brain injury stroke |
| url | http://www.sciencedirect.com/science/article/pii/S2666250722004473 |
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