Skip to main content
SpringerLink
Log in

ECMO Patient in Intensive Care Unit: Usefulness of Neurosonology in Neurologic Monitoring

  • Chapter
  • First Online:
Neurosonology in Critical Care

  • 1751 Accesses

Abstract

Extracorporeal membrane oxygenation (ECMO) is used to provide cardiac and/or pulmonary support in patients refractory to conventional therapies. It is increasingly used in various clinical acute settings and associated with cerebrovascular complications responsible for high morbidity and mortality.

Studies have shown alterations in cerebral blood flow (CBF) during ECMO support are potentially associated with neurological complications. Early detection of cerebral hemodynamics changes could improve patient’s prognosis, and various neuromonitoring tools are available to assess CBF during ECMO support. Transcranial Doppler (TCD) has numerous advantages, as it is a noninvasive procedure, available at bedside, and able to detect cerebral hemodynamic changes in real time and microembolism.

The aim of this chapter is to review literature concerning dynamic monitoring of CBF by TCD during ECMO and to give practical considerations.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 179.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Davies A, et al. Extracorporeal membrane oxygenation for 2009 influenza A(H1N1) acute respiratory distress syndrome. JAMA. 2009;302(17):1888–95.

    Article  CAS  PubMed  Google Scholar 

  2. Luyt CE, et al. Long-term outcomes of pandemic 2009 influenza A(H1N1)-associated severe ARDS. Chest. 2012;142(3):583–92.

    Article  CAS  PubMed  Google Scholar 

  3. Combes A, et al. Position paper for the organization of extracorporeal membrane oxygenation programs for acute respiratory failure in adult patients. Am J Respir Crit Care Med. 2014;190(5):488–96.

    Article  PubMed  Google Scholar 

  4. Abrams D, et al. Position paper for the organization of ECMO programs for cardiac failure in adults. Intensive Care Med. 2018;44(6):717–29.

    Article  PubMed  Google Scholar 

  5. Marasco SF, et al. Review of ECMO (extra corporeal membrane oxygenation) support in critically ill adult patients. Heart Lung Circ. 2008;17(Suppl 4):S41–7.

    Article  PubMed  Google Scholar 

  6. Brechot N, et al. Intra-aortic balloon pump protects against hydrostatic pulmonary oedema during peripheral venoarterial-extracorporeal membrane oxygenation. Eur Heart J Acute Cardiovasc Care. 2018;7(1):62–9.

    Article  PubMed  Google Scholar 

  7. Madershahian N, et al. The acute effect of IABP-induced pulsatility on coronary vascular resistance and graft flow in critical ill patients during ECMO. J Cardiovasc Surg. 2011;52(3):411–8.

    CAS  Google Scholar 

  8. Madershahian N, et al. The impact of intraaortic balloon counterpulsation on bypass graft flow in patients with peripheral ECMO. J Card Surg. 2009;24(3):265–8.

    Article  PubMed  Google Scholar 

  9. Ma P, et al. Combining ECMO with IABP for the treatment of critically ill adult heart failure patients. Heart Lung Circ. 2014;23(4):363–8.

    Article  PubMed  Google Scholar 

  10. Chung ES, et al. Results of extracorporeal membrane oxygenation (ECMO) support before coronary reperfusion in cardiogenic shock with acute myocardial infarction. Korean J Thorac Cardiovasc Surg. 2011;44(4):273–8.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Combes A, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med. 2018;378(21):1965–75.

    Article  PubMed  Google Scholar 

  12. Extracorporeal Life Support Organization. Registry report for all ECLS cases.

    Google Scholar 

  13. Mateen FJ, et al. Neurological injury in adults treated with extracorporeal membrane oxygenation. Arch Neurol. 2011;68(12):1543–9.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Mehta A, Ibsen LM. Neurologic complications and neurodevelopmental outcome with extracorporeal life support. World J Crit Care Med. 2013;2(4):40–7.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Risnes I, et al. Cerebral outcome in adult patients treated with extracorporeal membrane oxygenation. Ann Thorac Surg. 2006;81(4):1401–6.

    Article  PubMed  Google Scholar 

  16. Lewandowski K, et al. High survival rate in 122 ARDS patients managed according to a clinical algorithm including extracorporeal membrane oxygenation. Intensive Care Med. 1997;23(8):819–35.

    Article  CAS  PubMed  Google Scholar 

  17. Luyt CE, et al. Brain injury during venovenous extracorporeal membrane oxygenation. Intensive Care Med. 2016;23:23.

    Google Scholar 

  18. O’Brien NF, Hall MW. Extracorporeal membrane oxygenation and cerebral blood flow velocity in children. Pediatr Crit Care Med. 2013;14(3):e126–34.

    Article  PubMed  Google Scholar 

  19. Kavi T, et al. Transcranial Doppler changes in patients treated with extracorporeal membrane oxygenation. J Stroke Cerebrovasc Dis. 2016;25(12):2882–5.

    Article  PubMed  Google Scholar 

  20. Papademetriou MD, et al. Multichannel near infrared spectroscopy indicates regional variations in cerebral autoregulation in infants supported on extracorporeal membrane oxygenation. J Biomed Opt. 2012;17(6):067008.

    Article  PubMed  CAS  Google Scholar 

  21. Lassen NA, Christensen MS. Physiology of cerebral blood flow. Br J Anaesth. 1976;48(8):719–34.

    Article  CAS  PubMed  Google Scholar 

  22. Kuschinsky W, Wahl M. Local chemical and neurogenic regulation of cerebral vascular resistance. Physiol Rev. 1978;58(3):656–89.

    Article  CAS  PubMed  Google Scholar 

  23. Winn HR, et al. Brain adenosine production in rat during sustained alteration in systemic blood pressure. Am J Phys. 1980;239(5):H636–41.

    CAS  Google Scholar 

  24. Wei EP, Kontos HA. Increased venous pressure causes myogenic constriction of cerebral arterioles during local hyperoxia. Circ Res. 1984;55(2):249–52.

    Article  CAS  PubMed  Google Scholar 

  25. Hamel E. Perivascular nerves and the regulation of cerebrovascular tone. J Appl Physiol (1985). 2006;100(3):1059–64.

    Article  Google Scholar 

  26. Waeber C, Moskowitz MA. Migraine as an inflammatory disorder. Neurology. 2005;64(10 Suppl 2):S9–15.

    Article  PubMed  Google Scholar 

  27. McHenry LC, et al. Cerebral autoregulation in man. Stroke. 1974;5(6):695–706.

    Article  PubMed  Google Scholar 

  28. Faraci FM, Mayhan WG, Heistad DD. Segmental vascular responses to acute hypertension in cerebrum and brain stem. Am J Phys. 1987;252(4 Pt 2):H738–42.

    CAS  Google Scholar 

  29. Bouma GJ, et al. Blood pressure and intracranial pressure-volume dynamics in severe head injury: relationship with cerebral blood flow. J Neurosurg. 1992;77(1):15–9.

    Article  CAS  PubMed  Google Scholar 

  30. Czosnyka M, et al. Cerebral autoregulation following head injury. J Neurosurg. 2001;95(5):756–63.

    Article  CAS  PubMed  Google Scholar 

  31. Powers WJ, et al. Autoregulation after ischaemic stroke. J Hypertens. 2009;27(11):2218–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Panerai RB, et al. Dynamic cerebral autoregulation following acute ischaemic stroke: comparison of transcranial Doppler and magnetic resonance imaging techniques. J Cereb Blood Flow Metab. 2016;36(12):2194–202.

    Article  CAS  PubMed  Google Scholar 

  33. Oeinck M, et al. Dynamic cerebral autoregulation in acute intracerebral hemorrhage. Stroke. 2013;44(10):2722–8.

    Article  PubMed  Google Scholar 

  34. Ma H, et al. Temporal course of dynamic cerebral autoregulation in patients with intracerebral hemorrhage. Stroke. 2016;47(3):674–81.

    Article  CAS  PubMed  Google Scholar 

  35. Budohoski KP, et al. Impairment of cerebral autoregulation predicts delayed cerebral ischemia after subarachnoid hemorrhage: a prospective observational study. Stroke. 2012;43(12):3230–7.

    Article  PubMed  Google Scholar 

  36. Otite F, et al. Impaired cerebral autoregulation is associated with vasospasm and delayed cerebral ischemia in subarachnoid hemorrhage. Stroke. 2014;45(3):677–82.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Short BL. The effect of extracorporeal life support on the brain: a focus on ECMO. Semin Perinatol. 2005;29(1):45–50.

    Article  PubMed  Google Scholar 

  38. Liem KD, et al. Cerebral oxygenation and hemodynamics during induction of extracorporeal membrane oxygenation as investigated by near infrared spectrophotometry. Pediatrics. 1995;95(4):555–61.

    Article  CAS  PubMed  Google Scholar 

  39. Fenik JC, Rais-Bahrami K. Neonatal cerebral oximetry monitoring during ECMO cannulation. J Perinatol. 2009;29(5):376–81.

    Article  CAS  PubMed  Google Scholar 

  40. Tranmer BI, et al. Pulsatile versus nonpulsatile blood flow in the treatment of acute cerebral ischemia. Neurosurgery. 1986;19(5):724–31.

    Article  CAS  PubMed  Google Scholar 

  41. Joshi B, et al. Predicting the limits of cerebral autoregulation during cardiopulmonary bypass. Anesth Analg. 2012;114(3):503–10.

    Article  PubMed  Google Scholar 

  42. Hori D, et al. Hypotension after cardiac operations based on autoregulation monitoring leads to brain cellular injury. Ann Thorac Surg. 2015;100(2):487–93.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Short BL, et al. Impairment of cerebral autoregulation during extracorporeal membrane oxygenation in newborn lambs. Pediatr Res. 1993;33(3):289–94.

    Article  CAS  PubMed  Google Scholar 

  44. Tian F, et al. Impairment of cerebral autoregulation in pediatric extracorporeal membrane oxygenation associated with neuroimaging abnormalities. Neurophotonics. 2017;4(4):041410.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Tian F, et al. Wavelet coherence analysis of dynamic cerebral autoregulation in neonatal hypoxic-ischemic encephalopathy. Neuroimage Clin. 2016;11:124–32.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Cakici M, et al. Controlled flow diversion in hybrid venoarterial-venous extracorporeal membrane oxygenation. Interact Cardiovasc Thorac Surg. 2018;26(1):112–8.

    Article  PubMed  Google Scholar 

  47. Doll N, et al. Five-year results of 219 consecutive patients treated with extracorporeal membrane oxygenation for refractory postoperative cardiogenic shock. Ann Thorac Surg. 2004;77(1):151–7. discussion 157

    Article  PubMed  Google Scholar 

  48. Yang F, et al. Effects of intra-aortic balloon pump on cerebral blood flow during peripheral venoarterial extracorporeal membrane oxygenation support. J Transl Med. 2014;12:106.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  49. Meng L, Gelb AW. Regulation of cerebral autoregulation by carbon dioxide. Anesthesiology. 2015;122(1):196–205.

    Article  PubMed  Google Scholar 

  50. Weber TR, Kountzman B. The effects of venous occlusion on cerebral blood flow characteristics during ECMO. J Pediatr Surg. 1996;31(8):1124–7.

    Article  CAS  PubMed  Google Scholar 

  51. Fukuda S, et al. Comparison of venoarterial versus venovenous access in the cerebral circulation of newborns undergoing extracorporeal membrane oxygenation. Pediatr Surg Int. 1999;15(2):78–84.

    Article  CAS  PubMed  Google Scholar 

  52. Taylor GA, et al. Intracranial flow patterns in infants undergoing extracorporeal membrane oxygenation: preliminary observations with Doppler US. Radiology. 1987;165(3):671–4.

    Article  CAS  PubMed  Google Scholar 

  53. van de Bor M, et al. Extracorporeal membrane oxygenation and cerebral blood flow velocity in newborn infants. Crit Care Med. 1990;18(1):10–3.

    Article  PubMed  Google Scholar 

  54. Schachtrupp A, et al. Influence of intra-aortic balloon pumping on cerebral blood flow pattern in patients after cardiac surgery. Eur J Anaesthesiol. 2005;22(3):165–70.

    Article  CAS  PubMed  Google Scholar 

  55. Gee W, et al. Assessment of intra-aortic balloon pumping by ocular pneumoplethysmography. Am Surg. 1986;52(9):489–91.

    CAS  PubMed  Google Scholar 

  56. Marinoni M, et al. Retrospective analysis of transcranial Doppler patterns in veno-arterial extracorporeal membrane oxygenation patients: feasibility of cerebral circulatory arrest diagnosis. ASAIO J. 2018;64(2):175–82.

    Article  PubMed  Google Scholar 

  57. Nasr DM, Rabinstein AA. Neurologic complications of extracorporeal membrane oxygenation. J Clin Neurol. 2015;11(4):383–9.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Omar HR, et al. Incidence and predictors of ischemic cerebrovascular stroke among patients on extracorporeal membrane oxygenation support. J Crit Care. 2016;32:48–51.

    Article  PubMed  Google Scholar 

  59. Meyer AD, et al. Platelet-derived microparticles generated by neonatal extracorporeal membrane oxygenation systems. ASAIO J. 2015;61(1):37–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Foster PP, et al. Patent foramen ovale and paradoxical systemic embolism: a bibliographic review. Aviat Space Environ Med. 2003;74(6 Pt 2):B1–64.

    PubMed  Google Scholar 

  61. Stocchetti N, et al. Hyperventilation in head injury: a review. Chest. 2005;127(5):1812–27.

    Article  PubMed  Google Scholar 

  62. Brunser AM, et al. The role of TCD in the evaluation of acute stroke. J Neuroimaging. 2016;26(4):420–5.

    Article  PubMed  Google Scholar 

  63. Muehrcke DD, et al. Complications of extracorporeal life support systems using heparin-bound surfaces. The risk of intracardiac clot formation. J Thorac Cardiovasc Surg. 1995;110(3):843–51.

    Article  CAS  PubMed  Google Scholar 

  64. Jiang J, et al. Microembolic signal monitoring of TOASTclassified cerebral infarction patients. Mol Med Rep. 2013;8(4):1135–42.

    Article  CAS  PubMed  Google Scholar 

  65. Best LM, et al. Transcranial Doppler ultrasound detection of microemboli as a predictor of cerebral events in patients with symptomatic and asymptomatic carotid disease: a systematic review and meta-analysis. Eur J Vasc Endovasc Surg. 2016;52(5):565–80.

    Article  CAS  PubMed  Google Scholar 

  66. Zanatta P, et al. Microembolic signals and strategy to prevent gas embolism during extracorporeal membrane oxygenation. J Cardiothorac Surg. 2010;5:5.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Marinoni M, et al. Cerebral microemboli detected by transcranial doppler in patients treated with extracorporeal membrane oxygenation. Acta Anaesthesiol Scand. 2016;60(7):934–44.

    Article  CAS  PubMed  Google Scholar 

  68. Hornig CR, Dorndorf W, Agnoli AL. Hemorrhagic cerebral infarction–a prospective study. Stroke. 1986;17(2):179–85.

    Article  CAS  PubMed  Google Scholar 

  69. Kasirajan V, et al. Risk factors for intracranial hemorrhage in adults on extracorporeal membrane oxygenation. Eur J Cardiothorac Surg. 1999;15(4):508–14.

    Article  CAS  PubMed  Google Scholar 

  70. Martucci G, Lo Re V, Arcadipane A. Neurological injuries and extracorporeal membrane oxygenation: the challenge of the new ECMO era. Neurol Sci. 2016;19:19.

    Google Scholar 

  71. Hingorani A, et al. Causes of early post carotid endartectomy stroke in a recent series: the increasing importance of hyperperfusion syndrome. Acta Chir Belg. 2002;102(6):435–8.

    Article  CAS  PubMed  Google Scholar 

  72. Giani M, et al. Apnea test during brain death assessment in mechanically ventilated and ECMO patients. Intensive Care Med. 2016;42(1):72–81.

    Article  PubMed  Google Scholar 

  73. Sloan MA, et al. Assessment: transcranial Doppler ultrasonography: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2004;62(9):1468–81.

    Article  CAS  PubMed  Google Scholar 

  74. Wahlster S, et al. Brain death declaration: practices and perceptions worldwide. Neurology. 2015;84(18):1870–9.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Pugin D, Woimant F. Stroke care in the ICU: general supportive treatment. Experts’ recommendations. Rev Neurol (Paris). 2012;168(6–7):490–500.

    Article  CAS  Google Scholar 

  76. Atkinson JL, Anderson RE, Sundt TM. The effect of carbon dioxide on the diameter of brain capillaries. Brain Res. 1990;517(1–2):333–40.

    Article  CAS  PubMed  Google Scholar 

  77. Kazmi SO, et al. Cerebral pathophysiology in extracorporeal membrane oxygenation: pitfalls in daily clinical management. Crit Care Res Pract. 2018;2018:3237810.

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Intensive Medicine Neurologic Reanimation, Hôpital Pitié-Salpêtrière, Paris, France

    Loïc Le Guennec

  2. Sorbonne University, Paris, France

    Loïc Le Guennec

  3. Reanimation Service, Institute of Cardiology, Groupe Hospital Pitié–Salpêtrière, Public Assistance – Hospital of Paris, Paris, France

    Alain Combes

  4. Sorbonne University, UPMC University Paris 06, Institute of Cardiometabolism and Nutrition, Paris, France

    Alain Combes

Authors
  1. Loïc Le Guennec
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alain Combes
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Loïc Le Guennec .

Editor information

Editors and Affiliations

  1. Department of Critical Care, University of Buenos Aires, Buenos Aires, Argentina

    Camilo N. Rodríguez

  2. Stroke Unit & Neurosonology Lab, University of Padua School of Medicine, Padova, Italy

    Claudio Baracchini

  3. Department of Critical Care and Anesthesiology, Fundación Valle del Lili, Cali, Colombia

    Jorge H. Mejia-Mantilla

  4. Department of Clinical Neurosciences Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK

    Marek Czosnyka

  5. Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Jose I Suarez

  6. President of Hungarian Neurological Society, Department of Neurology, Clinical Center Debrecen University, Debrecen, Hungary

    László Csiba

  7. Intensive Care Unit, Clinics Hospital, Universidad de la Republica School of Medicine, Montevideo, Uruguay

    Corina Puppo

  8. Center for Neurological Vascular Diagnostics, Munich, Germany

    Eva Bartels

Algorithm

Algorithm

figure a

ABCD airway-breathing-circulation-disability, GCS Glasgow coma score, LVEF left ventricular ejection fraction, CBF Cerebral blood flow, MV mechanical ventilation, IABP Intra-aortic blood pump, PI pulsatility index, EDV end-diastolic velocity, FA femoral artery, SCA subclavian artery, AAo aortic, CBV cerebral blood volume, FO foramen ovale, AKI acute renal injury, CPP cerebral perfusion pressure

Rights and permissions

Reprints and permissions

Copyright information

© 2022 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Le Guennec, L., Combes, A. (2022). ECMO Patient in Intensive Care Unit: Usefulness of Neurosonology in Neurologic Monitoring. In: Rodríguez, C.N., et al. Neurosonology in Critical Care . Springer, Cham. https://doi.org/10.1007/978-3-030-81419-9_48

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-81419-9_48

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-81418-2

  • Online ISBN: 978-3-030-81419-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation