Neuromonitoring detects brain injury in patients receiving extracorporeal membrane oxygenation support
Neuromonitoring detects brain injury in patients receiving extracorporeal membrane oxygenation support
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DOI：
10.1016/j.jtcvs.2021.09.063
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发表时间：
2023-05-10
影响因子：
6
通讯作者：
Cho, Sung-Min
中科院分区：
文献类型：
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作者：
Ong, Chin Siang;Etchill, Eric;Cho, Sung-Min
目的：对于体外膜肺氧合(ECMO)患者的最佳神经学监测方法的标准化方案的证据有限。我们之前介绍了一系列神经学检查、脑电检查、经颅多普勒超声和体感诱发电位的无创多模式神经监测。本研究的目的是检验标准化神经监测是否与急性脑损伤(ABI)的检测和患者预后的改善有关。方法：对接受神经危重护理会诊的ECMO患者进行回顾性分析，并对结果进行回顾。队列根据没有接受标准化神经监测的人(ERA 1：2016-2017)和接受标准化神经监测的人(ERA 2：2017-2020)进行分层。结果：共215例患者(平均年龄54岁，男性占60%)接受ECMO，其中静脉-动脉-ECMO占71%，ER1为70例，ER2为145例。在多变量Logistic回归分析中，标准化神经监测(优势比，2.24；95%可信区间，1.12-4.48；P=0.02)和体外循环前心脏骤停(优势比，2.17；95%可信区间，1.14-4.14；P=0.02)与ABI独立相关。在ER2中，神经功能恢复良好的患者比例更高(54%比30%；P=0.04)。结论：标准化的神经监测与ECMO患者的ABI增加有关。虽然神经监测不能防止ABI的发生，但通过及时的干预(例如，抗凝治疗、优化氧气输送和血压)，可以防止病情恶化，从而改善出院时的神经预后。(《胸心外科杂志》2023；165：2104-10)
Objective: There is limited evidence on standardized protocols for optimal neurological monitoring methods in patients receiving extracorporeal membrane oxygenation (ECMO). We previously introduced protocolized noninvasive multimodal neuromonitoring using serial neurological examinations, electroencephalography, transcranial Doppler ultrasound, and somatosensory evoked potentials. The purpose of this study was to examine if standardized neuromonitoring is associated with detection of acute brain injury (ABI) and improved patient outcomes.Methods: A retrospective analysis of ECMO patients who received neurocritical care consultation was performed and outcomes were reviewed. The cohort was stratified according to those who did not receive standardized neuromonitoring (era 1: 2016-2017) and those who received standardized neuromonitoring (era 2: 2017-2020). Multivariable logistic regression was used to evaluate the association between standardized neuromonitoring and ABI.Results: A total of 215 patients (mean age, 54 years; 60% male) underwent ECMO (71% venoarterial-ECMO) in our institution, 70 in era 1 and 145 in era 2. The proportion of patients diagnosed with ABI were 23% in era 1 and 33% in era 2 (P = .12). In multivariable logistic regression, standardized neuromonitoring (odds ratio, 2.24; 95% CI, 1.12-4.48; P = .02) and pre-ECMO cardiac arrest (odds ratio, 2.17; 95% CI, 1.14-4.14; P = .02) were independently associated with ABI. There was a greater proportion of patients with good neurological outcomes when discharged alive in era 2 (54% vs 30%; P = .04). Conclusions: Standardized neuromonitoring was associated with increased ABIs in ECMO patients. Although neuromonitoring does not prevent ABI from occurring, it might prevent worsening with timely interventions (eg, anticoagulation management, optimizing oxygen delivery and blood pressure), leading to improved neurological outcomes at discharge. (J Thorac Cardiovasc Surg 2023;165:2104-10)