TY - JOUR
T1 - Neurological Monitoring and Management for Adult Extracorporeal Membrane Oxygenation Patients
T2 - Extracorporeal Life Support Organization Consensus Guidelines
AU - Cho, Sung Min
AU - Hwang, Jaeho
AU - Chiarini, Giovanni
AU - Amer, Marwa
AU - Antonini, Marta Velia
AU - Barrett, Nicholas
AU - Belohlavek, Jan
AU - Blatt, Jason E.
AU - Brodie, Daniel
AU - Dalton, Heidi J.
AU - Diaz, Rodrigo
AU - Elhazmi, Alyaa
AU - Tahsili-Fahadan, Pouya
AU - Fanning, Jonathon
AU - Fraser, John
AU - Hoskote, Aparna
AU - Jung, Jae Seung
AU - Lotz, Christopher
AU - Maclaren, Graeme
AU - Peek, Giles
AU - Polito, Angelo
AU - Pudil, Jan
AU - Raman, Lakshmi
AU - Ramanathan, Kollengode
AU - DoS Reis Miranda, Dinis
AU - Rob, Daniel
AU - Rojas, Leonardo Salazar
AU - Taccone, Fabio Silvio
AU - Whitman, Glenn
AU - Zaaqoq, Akram M.
AU - Lorusso, Roberto
N1 - Publisher Copyright:
© 2024 The Author(s).
PY - 2024/12
Y1 - 2024/12
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85210997122&partnerID=8YFLogxK
U2 - 10.1097/MAT.0000000000002312
DO - 10.1097/MAT.0000000000002312
M3 - Article
C2 - 39620302
AN - SCOPUS:85210997122
SN - 1058-2916
VL - 70
SP - e169-e181
JO - ASAIO Journal
JF - ASAIO Journal
IS - 12
ER -