한빛사논문
Sung‑Min Cho1,2*, Jaeho Hwang1, Giovanni Chiarini3,4, Marwa Amer5,6, Marta V. Antonini7, Nicholas Barrett8, Jan Belohlavek9, Daniel Brodie10, Heidi J. Dalton11, Rodrigo Diaz12, Alyaa Elhazmi5,6, Pouya Tahsili‑Fahadan1,13, Jonathon Fanning14, John Fraser14, Aparna Hoskote15, Jae‑Seung Jung16, Christopher Lotz17, Graeme MacLaren18, Giles Peek19, Angelo Polito20, Jan Pudil9, Lakshmi Raman21, Kollengode Ramanathan18, Dinis Dos Reis Miranda22, Daniel Rob9, Leonardo Salazar Rojas23, Fabio Silvio Taccone24, Glenn Whitman2, Akram M. Zaaqoq25† and Roberto Lorusso3†
1Divisions of Neuroscience Critical Care and Cardiac Surgery Departments of Neurology, Neurosurgery, and Anaesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Phipps 455, Baltimore, MD 21287, USA.
2Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
3Cardiothoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.
4Division of Anaesthesiology, Intensive Care and Emergency Medicine, Spedali Civili University, Afliated Hospital of Brescia, Brescia, Italy.
5Medical/Critical Pharmacy Division, King Faisal Specialist Hospital and Research Center, 11564 Al Mathar Ash Shamali, Riyadh, Saudi Arabia.
6Alfaisal University College of Medicine, Riyadh, Saudi Arabia.
7Bufalini Hospital, AUSL della Romagna, Cesena, Italy.
8Department of Critical Care Medicine, Guy’s and St Thomas’ National Health Service Foundation Trust, London, UK.
92nd Department of Medicine, Cardiology and Angiologiy, General University Hospital and 1st School of Medicine, Charles University, Prague, Czech Republic.
10Division of Pulmonary, and Critical Care Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
11Departments of Surgery and Pediatrics, Creighton University, Omaha, NE, USA.
12Programa de Oxigenación Por Membrana Extracorpórea, Hospital San Juan de Dios Santiago, Santiago, Chile.
13Medical Critical Care Service, Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA, USA.
14Critical Care Research Group, Adult Intensive Care Services, The Prince Charles Hospital and University of Queensland, Rode Rd, Chermside, QLD 4032, Australia.
15Cardiorespiratory and Critical Care Division, Great Ormond Street Hospital for, Children National Health Service Foundation Trust, London, UK.
16Department of Thoracic and Cardiovascular Surgery, Korea University Medicine, Seoul, Republic of Korea.
17Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany.
18Cardiothoracic Intensive Care Unit, Department of Cardiac, Thoracic and Vascular Surgery, National University Health System, Singapore, Singapore.
19Congenital Heart Center, Departments of Surgery and Pediatrics, University of Florida, Gainesville, FL, USA.
20Pediatric Intensive Care Unit, Department of Woman, Child, and Adolescent Medicine, Geneva University Hospital, Geneva, Switzerland.
21Department of Pediatrics, Section Critical Care Medicine, Children’s Medical Center at Dallas, The University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA.
22Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands.
23ECMO Department, Fundacion Cardiovascular de Colombia, Floridablanca, Santander, Colombia.
24Department of Intensive Care, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Brussels, Belgium.
25Department of Anesthesiology, Division of Critical Care, University of Virginia, Charlottesville, VA, USA.
†Akram M. Zaaqoq and Roberto Lorusso have contributed equally as senior authors.
*Correspondence: Sung‑Min Cho
Abstract
Background: Critical care of patients on extracorporeal membrane oxygenation (ECMO) with acute brain injury (ABI) is notable for a lack of high-quality clinical evidence. Here, we offer guidelines for neurological care (neurological monitoring and management) of adults during and after ECMO support.
Methods: These guidelines are based on clinical practice consensus recommendations and scientific statements. We convened an international multidisciplinary consensus panel including 30 clinician-scientists with expertise in ECMO from all chapters of the Extracorporeal Life Support Organization (ELSO). We used a modified Delphi process with three rounds of voting and asked panelists to assess the recommendation levels.
Results: We identified five key clinical areas needing guidance: (1) neurological monitoring, (2) post-cannulation early physiological targets and ABI, (3) neurological therapy including medical and surgical intervention, (4) neurological prognostication, and (5) neurological follow-up and outcomes. The consensus produced 30 statements and recommendations regarding key clinical areas. We identified several knowledge gaps to shape future research efforts.
Conclusions: The impact of ABI on morbidity and mortality in ECMO patients is significant. Particularly, early detection and timely intervention are crucial for improving outcomes. These consensus recommendations and scientific statements serve to guide the neurological monitoring and prevention of ABI, and management strategy of ECMO-associated ABI.
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