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Neuromonitoring During ECMO Support in Children

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Abstract

Extracorporeal membrane oxygenation is a potentially lifesaving intervention for children with severe cardiac or respiratory failure. It is used with increasing frequency and in increasingly more complex and severe diseases. Neurological injuries are important causes of morbidity and mortality in children treated with extracorporeal membrane oxygenation and include ischemic stroke, intracranial hemorrhage, hypoxic-ischemic injury, and seizures. In this review, we discuss the epidemiology and pathophysiology of neurological injury in patients supported with extracorporeal membrane oxygenation, and we review the current state of knowledge for available modalities of monitoring neurological function in these children. These include structural imaging with computed tomography and ultrasound, cerebral blood flow monitoring with near-infrared spectroscopy and transcranial Doppler ultrasound, and physiological monitoring with electroencephalography and plasma biomarkers. We highlight areas of need and emerging advances that will improve our understanding of neurological injury related to extracorporeal membrane oxygenation and help to reduce the burden of neurological sequelae in these children.

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Funding

This work was supported by the funding from the National Institute of Neurological Disorders and Stroke of the National Institutes of Health under Award Number R01NS106292 (MMB).

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Authors and Affiliations

  1. Department of Neurology, Johns Hopkins University School of Medicine, 200 N. Wolfe Street, Suite 2158, Baltimore, MD, USA

    Ryan J. Felling

  2. Department of Anesthesia Critical Care Medicine, Children’s Hospital Los Angeles, Los Angeles, CA, USA

    Asavari Kamerkar

  3. Division of Pediatric Critical Care, Indiana School of Medicine, Indianapolis, IN, USA

    Matthew L. Friedman

  4. Division of Pediatric Critical Care, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA

    Ahmed S. Said

  5. Department of Neurology, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA

    Kerri L. LaRovere

  6. Division of Critical Care Medicine, Department of Pediatrics, Children’s National Medical Center, Washington, DC, USA

    Michael J. Bell

  7. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Melania M. Bembea

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  1. Ryan J. Felling
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  7. Melania M. Bembea
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All listed authors have met the requirements for authorship, including the following: substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Felling, R.J., Kamerkar, A., Friedman, M.L. et al. Neuromonitoring During ECMO Support in Children. Neurocrit Care 39, 701–713 (2023). https://doi.org/10.1007/s12028-023-01675-8

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