Characterization of Cerebral Hemodynamics with TCD in Patients Undergoing VA-ECMO and VV-ECMO: a Prospective Observational Study

Neurocritical Care - Tập 38 - Trang 407-413 - 2022
Giorgio Caturegli1, Lucy Q. Zhang1, Yunis Mayasi1, Aaron M. Gusdon1, Bahattin Ergin1, Vladimir Ponomarev1, Bo Soo Kim2, Steven Keller2, Romergryko G. Geocadin1, Glenn J. R. Whitman3, Sung-Min Cho1, Wendy Ziai1
1Division of Neurosciences Critical Care, Departments of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
2Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
3Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, USA

Tóm tắt

Extracorporeal membrane oxygenation has a high risk of acute brain injury and resultant mortality. Transcranial Doppler characterizes cerebral hemodynamics in real time, but limited data exist on its interpretation in ECMO. Here, we report TCD mean flow velocity and pulsatility index in a large ECMO population. This was a prospective cohort study at a tertiary care center. The patients were adults on venoarterial ECMO or venovenous ECMO undergoing TCD studies. A total of 135 patients underwent a total of 237 TCD studies while on VA-ECMO (n = 95, 70.3%) or VV-ECMO (n = 40, 29.6%). MFVs were captured reliably (approximately 90%) and were similar to a published healthy cohort in all vessels except the internal carotid artery. Presence of a recordable PI was strongly associated with ECMO mode (57% in VA vs. 95% in VV, p < 0.001). Absence of TCD pulsatility was associated with intraparenchymal hemorrhage (14.7 vs. 1.6%, p = 0.03) in VA-ECMO patients. Transcranial Doppler analysis in a single-center cohort of VA-ECMO and VV-ECMO patients demonstrates similar MFVs and PIs. Absence of PIs was associated with a higher frequency of intraparenchymal hemorrhage and a composite bleeding event. However, cautious interpretation and external validation is necessary for these findings with a multicenter study with a larger sample size.

Tài liệu tham khảo

Organization ELS, ECLS registry report international summary. Ann Arbor. 2020.

Abrams D, Combes A, Brodie D. Extracorporeal membrane oxygenation in cardiopulmonary disease in adults. J Am Coll Cardiol. 2014;63(25A):2769–78.

Cho SM, Canner J, Caturegli G, Choi CW, Etchill E, Giuliano K, et al. Risk factors of ischemic and hemorrhagic strokes during venovenous extracorporeal membrane oxygenation: analysis of data from the extracorporeal life support organization registry. Crit Care Med. 2021;49(1):91–101.

Cho SM, Canner J, Chiarini G, Calligy K, Caturegli G, Rycus P, et al. Modifiable risk factors and mortality from ischemic and hemorrhagic strokes in patients receiving venoarterial extracorporeal membrane oxygenation: results from the extracorporeal life support organization registry. Crit Care Med. 2020;48(10):e897-905.

Lorusso R, Barili F, Mauro MD, Gelsomino S, Parise O, Rycus PT, et al. In-hospital neurologic complications in adult patients undergoing venoarterial extracorporeal membrane oxygenation: results from the extracorporeal life support organization registry. Crit Care Med. 2016;44(10):e964–72.

Lorusso R, Gelsomino S, Parise O, Di Mauro M, Barili F, Geskes G, et al. Neurologic injury in adults supported with veno-venous extracorporeal membrane oxygenation for respiratory failure: findings from the extracorporeal life support organization database. Crit Care Med. 2017;45(8):1389–97.

Cho SM, Geocadin RG, Caturegli G, Chan V, White B, Dodd OJ, et al. Understanding characteristics of acute brain injury in adult extracorporeal membrane oxygenation: an autopsy study. Crit Care Med. 2020;48(6):e532–6.

Caturegli G, Cho SM, White B, Chen LL. Acute brain injury in infant venoarterial extracorporeal membrane oxygenation: an autopsy study. Pediatric Crit Care Med J Soc Crit Care Med World Fed Pediatr Intensive Crit Care Soc. 2021;22(3):297–302.

Mateen FJ, Muralidharan R, Shinohara RT, Parisi JE, Schears GJ, Wijdicks EF. Neurological injury in adults treated with extracorporeal membrane oxygenation. Arch Neurol. 2011;68(12):1543–9.

Sutter R, Tisljar K, Marsch S. Acute neurologic complications during extracorporeal membrane oxygenation: a systematic review. Crit Care Med. 2018;46(9):1506–13.

Cho SM, Deshpande A, Pasupuleti V, Hernandez AV, Uchino K. Radiographic and clinical brain infarcts in cardiac and diagnostic procedures: a systematic review and meta-analysis. Stroke. 2017;48(10):2753–9.

Cho SM, Ziai W, Mayasi Y, Gusdon AM, Creed J, Sharrock M, et al. Noninvasive neurological monitoring in extracorporeal membrane oxygenation. ASAIO J. 2020;66(4):388–93.

Kavi T, Esch M, Rinsky B, Rosengart A, Lahiri S, Lyden PD. Transcranial doppler changes in patients treated with extracorporeal membrane oxygenation. J Stroke Cerebrovasc Dis Off J Natl Stroke Assoc. 2016;25(12):2882–5.

Marinoni M, Migliaccio ML, Trapani S, Bonizzoli M, Gucci L, Cianchi G, et al. Cerebral microemboli detected by transcranial doppler in patients treated with extracorporeal membrane oxygenation. Acta Anaesthesiol Scand. 2016;60(7):934–44.

Rilinger JF, Smith CM, deRegnier RAO, Goldstein JL, Mills MG, Reynolds M, et al. Transcranial doppler identification of neurologic injury during pediatric extracorporeal membrane oxygenation therapy. J Stroke Cerebrovasc Dis Off J Natl Stroke Assoc. 2017;26(10):2336–45.

Salna M, Ikegami H, Willey JZ, Garan AR, Cevasco M, Chan C, et al. Transcranial Doppler is an effective method in assessing cerebral blood flow patterns during peripheral venoarterial extracorporeal membrane oxygenation. J Card Surg. 2019;34(6):447–52.

Melmed KR, Schlick KH, Rinsky B, Dumitrascu OM, Volod O, Nezhad M, et al. Assessing cerebrovascular hemodynamics using transcranial doppler in patients with mechanical circulatory support devices. J Neuroimaging Off J Am Soc Neuroimaging. 2020;30(3):297–302.

White H, Venkatesh B. Applications of transcranial doppler in the ICU: a review. Intensive Care Med. 2006;32(7):981–94.

Pavlushkov E, Berman M, Valchanov K. Cannulation techniques for extracorporeal life support. Ann Transl Med. 2017;5(4):70.

Schuurman PR, Albrecht KW. Intraoperative changes of transcranial doppler velocity: relation to arterial oxygen content and whole-blood viscosity. Ultrasound Med Biol. 1999;25(1):151–4.

D’Andrea A, Conte M, Scarafile R, Riegler L, Cocchia R, Pezzullo E, et al. Transcranial doppler ultrasound: physical principles and principal applications in neurocritical care unit. J Cardiovasc Echogr. 2016;26(2):28–41.

Alexandrov AV, Sloan MA, Wong LK, Douville C, Razumovsky AY, Koroshetz WJ, et al. Practice standards for transcranial doppler ultrasound: part I–test performance. J Neuroimaging Off J Am Soc Neuroimaging. 2007;17(1):11–8.

Tegeler CH, Crutchfield K, Katsnelson M, Kim J, Tang R, Passmore Griffin L, et al. Transcranial doppler velocities in a large, healthy population. J Neuroimaging Off J Am Soc Neuroimaging. 2013;23(3):466–72.

Sharma AK, Bathala L, Batra A, Mehndiratta MM, Sharma VK. Transcranial doppler: techniques and advanced applications: part 2. Ann Indian Acad Neurol. 2016;19(1):102–7.

Hong JM, Chung CS, Bang OY, Yong SW, Joo IS, Huh K. Vertebral artery dominance contributes to basilar artery curvature and peri-vertebrobasilar junctional infarcts. J Neurol Neurosurg Psychiatry. 2009;80(10):1087–92.

Chen X, Xu J, Zhang Y, Lin M, Wang H, Song Y. Evaluation of hemodynamic characteristics in posterior circulation infarction patients with vertebral artery dominance by color doppler flow imaging and transcranial doppler sonography. Int J Neurosci. 2021;131(11):1078–86.

Veraar CM, Rinösl H, Kühn K, Skhirtladze-Dworschak K, Felli A, Mouhieddine M, et al. Non-pulsatile blood flow is associated with enhanced cerebrovascular carbon dioxide reactivity and an attenuated relationship between cerebral blood flow and regional brain oxygenation. Crit Care. 2019;23(1):426.

Shou BL, Wilcox C, Florissi I, Kalra A, Caturegli G, Zhang LQ, et al. Early low pulse pressure in VA-ECMO is associated with acute brain injury. Neurocrit Care. 2022. https://doi.org/10.1007/s12028-022-01607-y.

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Neurocritical Care

Tập 38

407-413

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