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Open Access 01-12-2024 | ECMO | Guideline

Neurological monitoring and management for adult extracorporeal membrane oxygenation patients: Extracorporeal Life Support Organization consensus guidelines

Authors: Sung-Min Cho, Jaeho Hwang, Giovanni Chiarini, Marwa Amer, Marta V. Antonini, Nicholas Barrett, Jan Belohlavek, Daniel Brodie, Heidi J. Dalton, Rodrigo Diaz, Alyaa Elhazmi, Pouya Tahsili-Fahadan, Jonathon Fanning, John Fraser, Aparna Hoskote, Jae-Seung Jung, Christopher Lotz, Graeme MacLaren, Giles Peek, Angelo Polito, Jan Pudil, Lakshmi Raman, Kollengode Ramanathan, Dinis Dos Reis Miranda, Daniel Rob, Leonardo Salazar Rojas, Fabio Silvio Taccone, Glenn Whitman, Akram M. Zaaqoq, Roberto Lorusso

Published in: Critical Care | Issue 1/2024

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.

Available only for authorised users

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Title: Neurological monitoring and management for adult extracorporeal membrane oxygenation patients: Extracorporeal Life Support Organization consensus guidelines
Authors: Sung-Min Cho
Jaeho Hwang
Giovanni Chiarini
Marwa Amer
Marta V. Antonini
Nicholas Barrett
Jan Belohlavek
Daniel Brodie
Heidi J. Dalton
Rodrigo Diaz
Alyaa Elhazmi
Pouya Tahsili-Fahadan
Jonathon Fanning
John Fraser
Aparna Hoskote
Jae-Seung Jung
Christopher Lotz
Graeme MacLaren
Giles Peek
Angelo Polito
Jan Pudil
Lakshmi Raman
Kollengode Ramanathan
Dinis Dos Reis Miranda
Daniel Rob
Leonardo Salazar Rojas
Fabio Silvio Taccone
Glenn Whitman
Akram M. Zaaqoq
Roberto Lorusso
Publication date: 01-12-2024
Publisher: BioMed Central
Keywords: ECMO
Neuromonitoring
Diagnostics in Neurology
Cerebral Ischemic Stroke
Intracerebral Hemorrhage
Hypoxic-Ischemic Brain Injury
Neurological Emergencies
Cardiac Emergency
Pulmonary Emergencies
ECMO
Published in: Critical Care / Issue 1/2024
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/s13054-024-05082-z

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Neurological monitoring and management for adult extracorporeal membrane oxygenation patients: Extracorporeal Life Support Organization consensus guidelines

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