Semin Neurol
DOI: 10.1055/s-0041-1726284
Review Article

Brain Injury in Extracorporeal Membrane Oxygenation: A Multidisciplinary Approach

Giovanni Chiarini
1  Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
2  Division of Anesthesiology, Intensive Care and Emergency Medicine, Spedali Civili University, Affiliated Hospital of Brescia, Brescia, Italy
,
Sung-Min Cho
3  Departments of Neurology, Anesthesiology, and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
,
Glenn Whitman
4  Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
,
Frank Rasulo
2  Division of Anesthesiology, Intensive Care and Emergency Medicine, Spedali Civili University, Affiliated Hospital of Brescia, Brescia, Italy
,
Roberto Lorusso
1  Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
5  Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
› Author Affiliations

Abstract

Extracorporeal membrane oxygenation (ECMO) represents an established technique to provide temporary cardiac and/or pulmonary support. ECMO, in veno-venous, veno-arterial or in extracorporeal carbon dioxide removal modality, is associated with a high rate of brain injuries. These complications have been reported in 7 to 15% of adults and 20% of neonates, and are associated with poor survival. Thromboembolic events, loss of cerebral autoregulation, alteration of the blood–brain barrier, and hemorrhage related to anticoagulation represent the main causes of severe brain injury during ECMO. The most frequent forms of acute neurological injuries in ECMO patients are intracranial hemorrhage (2–21%), ischemic stroke (2–10%), seizures (2–6%), and hypoxic–ischemic brain injury; brain death may also occur in this population. Other frequent complications are infarction (1–8%) and cerebral edema (2–10%), as well as neuropsychological and psychiatric sequelae, including posttraumatic stress disorder.



Publication History

Publication Date:
13 April 2021 (online)

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