Dynamic Variables of Electroencephalography may be a Window into Brain Responsiveness

Excerpt

Extracorporeal cardiopulmonary support in the form of venoarterial or venovenous extracorporeal membrane oxygenation (ECMO) has become increasingly important and increasingly used in critical care in the last few years [1]. ECMO can be life-saving and has transformed the landscape of critical illness in a variety of conditions, including acute respiratory distress syndrome, cardiac failure, cardiac arrest, and SARS-CoV-2 infections, to name just a few. The neurocritical care of the comatose ECMO patient remains understudied and has not been the subject of prospective randomized studies, but a number of publications have demonstrated the occurrence of a variety of acute brain injuries (ABIs) during ECMO, such as ischemic stroke, brain hemorrhage, seizures, cerebral air embolism, delirium, and anoxic brain injury. ABIs occur in 7–20% of adults and neonates on ECMO [2‐4] and in around 5.9% of patients with COVID-19 on ECMO [5]. Detection of these ABIs remains challenging, but a number of studies have suggested that the use of noninvasive brain monitoring techniques, such as continuous electroencephalography (EEG), may be useful in detecting ABIs [6]. …