Cerebral microemboli during extracorporeal life support: a single-centre cohort study.

Kietaibl, Clemens; Horvat Menih, Ines; Engel, Adrian; Ullrich, Roman; Klein, Klaus U; Erdoes, Gabor (2021). Cerebral microemboli during extracorporeal life support: a single-centre cohort study. European journal of cardio-thoracic surgery, 61(1), pp. 172-179. Oxford University Press 10.1093/ejcts/ezab353

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OBJECTIVES

The aim of this study was to investigate the load and composition of cerebral microemboli in adult patients undergoing venoarterial extracorporeal life support (ECLS).

METHODS

Adult ECLS patients were investigated for the presence of cerebral microemboli and compared to critically ill, pressure-controlled ventilated controls and healthy volunteers. Cerebral microemboli were detected in both middle cerebral arteries for 30 min using transcranial Doppler ultrasound. Neurological outcome (ischaemic stroke, global brain ischaemia, intracerebral haemorrhage, seizure, metabolic encephalopathy, sensorimotor sequelae and neuropsychiatric disorders) was additionally evaluated.

RESULTS

Twenty ECLS patients (cannulations: 15 femoro-femoral, 4 femoro-subclavian, 1 femoro-aortic), 20 critically ill controls and 20 healthy volunteers were analysed. ECLS patients had statistically significantly more cerebral microemboli than critically ill controls {123 (43-547) [median (interquartile range)] vs 35 (16-74), difference: 88 [95% confidence interval (CI) 19-320], P = 0.023} and healthy volunteers [11 (5-12), difference: 112 (95% CI 45-351), P < 0.0001]. In ECLS patients, 96.5% (7346/7613) of cerebral microemboli were of gaseous composition, while solid cerebral microemboli [1 (0-5)] were detected in 12 out of 20 patients. ECLS patients had more neurological complications than critically ill controls (12/20 vs 3/20, P = 0.003). In ECLS patients, a high microembolic rate (>100/30 min) tended to be associated with neurological complications including ischaemic stroke, neuropsychiatric disorders, sensorimotor sequelae and non-convulsive status epilepticus (odds ratio 4.5, 95% CI 0.46-66.62; P = 0.559).

CONCLUSIONS

Our results indicate that adult ECLS patients are continuously exposed to many gaseous and, frequently, to few solid cerebral microemboli. Prolonged cerebral microemboli formation may contribute to neurological morbidity related to ECLS treatment.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, NCT02020759, https://clinicaltrials.gov/ct2/show/NCT02020759?term=erdoes&rank=1.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy

UniBE Contributor:

Erdoes, Gabor (B)

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1873-734X

Publisher:

Oxford University Press

Language:

English

Submitter:

Jeannie Wurz

Date Deposited:

14 Sep 2021 09:24

Last Modified:

29 Mar 2023 23:37

Publisher DOI:

10.1093/ejcts/ezab353

PubMed ID:

34406372

Uncontrolled Keywords:

Extracorporeal life support Extracorporeal membrane oxygenation Intracranial embolism Middle cerebral artery Ultrasonography, Doppler transcranial

BORIS DOI:

10.48350/158948

URI:

https://boris.unibe.ch/id/eprint/158948

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