Cerebral Blood Flow Hemispheric Asymmetry in Comatose Adults Receiving Extracorporeal Membrane Oxygenation
Peripheral veno-arterial extracorporeal membrane oxygenation (ECMO) artificially oxygenates and circulates blood retrograde from the femoral artery, potentially exposing the brain to asymmetric perfusion. Though ECMO patients frequently experience brain injury, neurologic exams and imaging are diffi...
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Published in | Frontiers in neuroscience Vol. 16; p. 858404 |
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Main Authors | , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Switzerland
Frontiers Research Foundation
11.04.2022
Frontiers Media S.A |
Subjects | |
Online Access | Get full text |
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Summary: | Peripheral veno-arterial extracorporeal membrane oxygenation (ECMO) artificially oxygenates and circulates blood retrograde from the femoral artery, potentially exposing the brain to asymmetric perfusion. Though ECMO patients frequently experience brain injury, neurologic exams and imaging are difficult to obtain. Diffuse correlation spectroscopy (DCS) non-invasively measures relative cerebral blood flow (rBF) at the bedside using an optical probe on each side of the forehead. In this study we observed interhemispheric rBF differences in response to mean arterial pressure (MAP) changes in adult ECMO recipients. We recruited 13 subjects aged 21-78 years (7 with cardiac arrest, 4 with acute heart failure, and 2 with acute respiratory distress syndrome). They were dichotomized
Glasgow Coma Scale Motor score (GCS-M) into comatose (GCS-M ≤ 4;
= 4) and non-comatose (GCS-M > 4;
= 9) groups. Comatose patients had greater interhemispheric rBF asymmetry (ASYM
) vs. non-comatose patients over a range of MAP values (29 vs. 11%,
= 0.009). ASYM
in comatose patients resolved near a MAP range of 70-80 mmHg, while rBF remained symmetric through a wider MAP range in non-comatose patients. Correlations between post-oxygenator pCO
or pH vs. ASYM
were significantly different between comatose and non-comatose groups. Our findings indicate that comatose patients are more likely to have asymmetric cerebral perfusion. |
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Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Edited by: Mamadou Diop, Western University, Canada This article was submitted to Brain Imaging Methods, a section of the journal Frontiers in Neuroscience These authors have contributed equally to this work and share first authorship Reviewed by: Heidi J. Dalton, Inova Health System, United States; Wesley Baker, Children’s Hospital of Philadelphia, United States |
ISSN: | 1662-4548 1662-453X 1662-453X |
DOI: | 10.3389/fnins.2022.858404 |