Neuromonitoring During Extracorporeal Membrane Oxygenation: A Systematic Review of the Literature

被引:45
作者
Bembea, Melania M. [1 ]
Felling, Ryan [2 ]
Anton, Blair [3 ]
Salorio, Cynthia F. [4 ,5 ,6 ]
Johnston, Michael V. [2 ]
机构
[1] Johns Hopkins Univ, Dept Anesthesiol & Crit Care Med, Baltimore, MD 21218 USA
[2] Johns Hopkins Univ, Dept Neurol, Baltimore, MD 21218 USA
[3] William H Welch Med Lib, Baltimore, MD USA
[4] Kennedy Krieger Inst, Baltimore, MD USA
[5] Johns Hopkins Univ, Dept Phys Med & Rehabil, Baltimore, MD USA
[6] Johns Hopkins Univ, Dept Psychiat & Behav Sci, Baltimore, MD USA
基金
美国国家卫生研究院;
关键词
biomarkers; cerebral oximetry; electroencephalography; extracorporeal membrane oxygenation; neurologic monitoring; neuromonitoring; AMPLITUDE-INTEGRATED ELECTROENCEPHALOGRAPHY; LIFE-SUPPORT; INTRACRANIAL HEMORRHAGE; BRAIN-INJURY; CEREBRAL OXYGENATION; PEDIATRIC-PATIENTS; S100B PROTEIN; DOPPLER US; INFANTS; ECMO;
D O I
10.1097/PCC.0000000000000415
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objective: Neurologic injury remains a significant morbidity and risk factor for mortality in critically ill patients undergoing extracorporeal membrane oxygenation. Our goal was to systematically review the literature on the use of neuromonitoring methods during extracorporeal membrane oxygenation. Data Sources: Electronic searches of PubMed, CINAHL, EMBASE, Web of Science, Cochrane, and Scopus were conducted in March 2014, using a combination of medical subject heading terms and text words to define concepts of extracorporeal life support, neurologic monitoring techniques, evaluation, and outcomes. Study Selection: Studies were selected based on inclusion and exclusion criteria defined a priori. Data Extraction: Two authors reviewed all citations independently. A standardized data extraction form was used to construct evidence tables by neuromonitoring method. Evidence was graded using the Oxford Evidence-Based Medicine scoring system. Data Synthesis: Of 3,459 unique citations, 39 studies met the inclusion criteria. Study designs were retrospective observational cohort studies (n = 20), prospective observational studies (n = 17), case-control studies (n = 2), and no interventional studies. Most studies evaluated newborns (n = 30). Extracorporeal membrane oxygenation neuromonitoring methods included neuroimaging (head ultrasound) (n = 12); intermittent, conventional, multichannel electroencephalography (n = 5); 1- to 2-channel amplitude-integrated electroencephalography (n = 2); Doppler ultrasound (n = 7); cerebral oximetry (n = 6); plasma brain injury biomarkers (n = 4); and other (n = 3). All evidence was graded 2B-4, with the majority of studies graded 3B (20/39 studies) and 4 (10/39 studies). Due to the heterogeneity of the studies included, aggregate analysis was not possible. Conclusions: Data supporting the use and effectiveness of current neuromonitoring methods are limited. Most studies have modest sample sizes, are observational in nature, and include patient populations that are of different ages and pathologies, with very limited data for pediatric and adult ages. Well-designed studies with adequate power and standardized short- and long-term outcomes are needed to develop guidelines for neuromonitoring and ultimately neuroprotection in patients on extracorporeal membrane oxygenation.
引用
收藏
页码:558 / 564
页数:7
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