Feasibility of non-invasive neuro-monitoring during extracorporeal membrane oxygenation in children

William M McDevitt; Margaret Farley; Darren Martin-Lamb; Timothy J Jones; Kevin P Morris; Stefano Seri; Barnaby R Scholefield

doi:10.1177/02676591211066804

Feasibility of non-invasive neuro-monitoring during extracorporeal membrane oxygenation in children

William M McDevitt, Margaret Farley, Darren Martin-Lamb, Timothy J Jones, Kevin P Morris, Stefano Seri, Barnaby R Scholefield

Research output: Contribution to journal › Article › peer-review

Abstract

INTRODUCTION: Detection of neurological complications during extracorporeal membrane oxygenation (ECMO) may be enhanced with non-invasive neuro-monitoring. We investigated the feasibility of non-invasive neuro-monitoring in a paediatric intensive care (PIC) setting.

METHODS: In a single centre, prospective cohort study we assessed feasibility of recruitment, and neuro-monitoring via somatosensory evoked potentials (SSEP), electroencephalography (EEG) and near infrared spectroscopy (NIRS) during venoarterial (VA) ECMO in paediatric patients (0-15 years). Measures were obtained within 24h of cannulation, during an intermediate period, and finally at decannulation or echo stress testing. SSEP/EEG/NIRS measures were correlated with neuro-radiology findings, and clinical outcome assessed via the Pediatric cerebral performance category (PCPC) scale 30 days post ECMO cannulation.

RESULTS: We recruited 14/20 (70%) eligible patients (median age: 9 months; IQR:4-54, 57% male) over an 18-month period, resulting in a total of 42 possible SSEP/EEG/NIRS measurements. Of these, 32/42 (76%) were completed. Missed recordings were due to lack of access/consent within 24 h of cannulation (5/42, 12%) or PIC death/discharge (5/42, 12%). In each patient, the majority of SSEP (8/14, 57%), EEG (8/14, 57%) and NIRS (11/14, 79%) test results were within normal limits. All patients with abnormal neuroradiology (4/10, 40%), and 6/7 (86%) with poor outcome (PCPC ≥4) developed indirect SSEP, EEG or NIRS measures of neurological complications prior to decannulation. No study-related adverse events or neuro-monitoring data interpreting issues were experienced.

CONCLUSION: Non-invasive neuro-monitoring (SSEP/EEG/NIRS) during ECMO is feasible and may provide early indication of neurological complications in this high-risk population.

Original language	English
Pages (from-to)	547-556
Number of pages	10
Journal	Perfusion
Volume	38
Issue number	3
Early online date	25 Feb 2022
DOIs	https://doi.org/10.1177/02676591211066804 https://doi.org/10.1177/02676591211066804
Publication status	Published - Apr 2023

Bibliographical note

Funding Information:
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: WMM is supported by the award of a West Midlands Higher Education England Funded Writing Grant and the NMAHPs Integrated Clinical Academic Research Unit, Birmingham Health Partners. Dr Scholefield is funded by a National Institute for Health Research (Clinician Scientist) Fellowship award. However, this project was not funded by the National Institute for Health Research. The views expressed are those of the authors and not necessarily those of the NHS, the National Institute for Health Research, Birmingham Health Partners, or the Department of Health and Social Care.

Publisher Copyright:
© The Author(s) 2022.

Keywords

Somatosensory evoked potential
electroencephalography
extracorporeal membrane oxygenation
near infrared spectroscopy
neuro-monitoring
neurological injury
prognostication

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging
Safety Research
Cardiology and Cardiovascular Medicine
Advanced and Specialised Nursing

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https://research.aston.ac.uk/en/publications/feasibility-of-non-invasive-neuro-monitoring-during-extracorporeaLicence: None: All rights reserved

Cite this

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title = "Feasibility of non-invasive neuro-monitoring during extracorporeal membrane oxygenation in children",

abstract = "INTRODUCTION: Detection of neurological complications during extracorporeal membrane oxygenation (ECMO) may be enhanced with non-invasive neuro-monitoring. We investigated the feasibility of non-invasive neuro-monitoring in a paediatric intensive care (PIC) setting.METHODS: In a single centre, prospective cohort study we assessed feasibility of recruitment, and neuro-monitoring via somatosensory evoked potentials (SSEP), electroencephalography (EEG) and near infrared spectroscopy (NIRS) during venoarterial (VA) ECMO in paediatric patients (0-15 years). Measures were obtained within 24h of cannulation, during an intermediate period, and finally at decannulation or echo stress testing. SSEP/EEG/NIRS measures were correlated with neuro-radiology findings, and clinical outcome assessed via the Pediatric cerebral performance category (PCPC) scale 30 days post ECMO cannulation.RESULTS: We recruited 14/20 (70%) eligible patients (median age: 9 months; IQR:4-54, 57% male) over an 18-month period, resulting in a total of 42 possible SSEP/EEG/NIRS measurements. Of these, 32/42 (76%) were completed. Missed recordings were due to lack of access/consent within 24 h of cannulation (5/42, 12%) or PIC death/discharge (5/42, 12%). In each patient, the majority of SSEP (8/14, 57%), EEG (8/14, 57%) and NIRS (11/14, 79%) test results were within normal limits. All patients with abnormal neuroradiology (4/10, 40%), and 6/7 (86%) with poor outcome (PCPC ≥4) developed indirect SSEP, EEG or NIRS measures of neurological complications prior to decannulation. No study-related adverse events or neuro-monitoring data interpreting issues were experienced.CONCLUSION: Non-invasive neuro-monitoring (SSEP/EEG/NIRS) during ECMO is feasible and may provide early indication of neurological complications in this high-risk population.",

keywords = "Somatosensory evoked potential, electroencephalography, extracorporeal membrane oxygenation, near infrared spectroscopy, neuro-monitoring, neurological injury, prognostication",

author = "McDevitt, {William M} and Margaret Farley and Darren Martin-Lamb and Jones, {Timothy J} and Morris, {Kevin P} and Stefano Seri and Scholefield, {Barnaby R}",

note = "Funding Information: The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: WMM is supported by the award of a West Midlands Higher Education England Funded Writing Grant and the NMAHPs Integrated Clinical Academic Research Unit, Birmingham Health Partners. Dr Scholefield is funded by a National Institute for Health Research (Clinician Scientist) Fellowship award. However, this project was not funded by the National Institute for Health Research. The views expressed are those of the authors and not necessarily those of the NHS, the National Institute for Health Research, Birmingham Health Partners, or the Department of Health and Social Care. Publisher Copyright: {\textcopyright} The Author(s) 2022.",

year = "2023",

month = apr,

doi = "10.1177/02676591211066804",

language = "English",

volume = "38",

pages = "547--556",

journal = "Perfusion",

issn = "0267-6591",

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T1 - Feasibility of non-invasive neuro-monitoring during extracorporeal membrane oxygenation in children

AU - McDevitt, William M

AU - Farley, Margaret

AU - Martin-Lamb, Darren

AU - Jones, Timothy J

AU - Morris, Kevin P

AU - Seri, Stefano

AU - Scholefield, Barnaby R

N1 - Funding Information: The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: WMM is supported by the award of a West Midlands Higher Education England Funded Writing Grant and the NMAHPs Integrated Clinical Academic Research Unit, Birmingham Health Partners. Dr Scholefield is funded by a National Institute for Health Research (Clinician Scientist) Fellowship award. However, this project was not funded by the National Institute for Health Research. The views expressed are those of the authors and not necessarily those of the NHS, the National Institute for Health Research, Birmingham Health Partners, or the Department of Health and Social Care. Publisher Copyright: © The Author(s) 2022.

PY - 2023/4

Y1 - 2023/4

N2 - INTRODUCTION: Detection of neurological complications during extracorporeal membrane oxygenation (ECMO) may be enhanced with non-invasive neuro-monitoring. We investigated the feasibility of non-invasive neuro-monitoring in a paediatric intensive care (PIC) setting.METHODS: In a single centre, prospective cohort study we assessed feasibility of recruitment, and neuro-monitoring via somatosensory evoked potentials (SSEP), electroencephalography (EEG) and near infrared spectroscopy (NIRS) during venoarterial (VA) ECMO in paediatric patients (0-15 years). Measures were obtained within 24h of cannulation, during an intermediate period, and finally at decannulation or echo stress testing. SSEP/EEG/NIRS measures were correlated with neuro-radiology findings, and clinical outcome assessed via the Pediatric cerebral performance category (PCPC) scale 30 days post ECMO cannulation.RESULTS: We recruited 14/20 (70%) eligible patients (median age: 9 months; IQR:4-54, 57% male) over an 18-month period, resulting in a total of 42 possible SSEP/EEG/NIRS measurements. Of these, 32/42 (76%) were completed. Missed recordings were due to lack of access/consent within 24 h of cannulation (5/42, 12%) or PIC death/discharge (5/42, 12%). In each patient, the majority of SSEP (8/14, 57%), EEG (8/14, 57%) and NIRS (11/14, 79%) test results were within normal limits. All patients with abnormal neuroradiology (4/10, 40%), and 6/7 (86%) with poor outcome (PCPC ≥4) developed indirect SSEP, EEG or NIRS measures of neurological complications prior to decannulation. No study-related adverse events or neuro-monitoring data interpreting issues were experienced.CONCLUSION: Non-invasive neuro-monitoring (SSEP/EEG/NIRS) during ECMO is feasible and may provide early indication of neurological complications in this high-risk population.

AB - INTRODUCTION: Detection of neurological complications during extracorporeal membrane oxygenation (ECMO) may be enhanced with non-invasive neuro-monitoring. We investigated the feasibility of non-invasive neuro-monitoring in a paediatric intensive care (PIC) setting.METHODS: In a single centre, prospective cohort study we assessed feasibility of recruitment, and neuro-monitoring via somatosensory evoked potentials (SSEP), electroencephalography (EEG) and near infrared spectroscopy (NIRS) during venoarterial (VA) ECMO in paediatric patients (0-15 years). Measures were obtained within 24h of cannulation, during an intermediate period, and finally at decannulation or echo stress testing. SSEP/EEG/NIRS measures were correlated with neuro-radiology findings, and clinical outcome assessed via the Pediatric cerebral performance category (PCPC) scale 30 days post ECMO cannulation.RESULTS: We recruited 14/20 (70%) eligible patients (median age: 9 months; IQR:4-54, 57% male) over an 18-month period, resulting in a total of 42 possible SSEP/EEG/NIRS measurements. Of these, 32/42 (76%) were completed. Missed recordings were due to lack of access/consent within 24 h of cannulation (5/42, 12%) or PIC death/discharge (5/42, 12%). In each patient, the majority of SSEP (8/14, 57%), EEG (8/14, 57%) and NIRS (11/14, 79%) test results were within normal limits. All patients with abnormal neuroradiology (4/10, 40%), and 6/7 (86%) with poor outcome (PCPC ≥4) developed indirect SSEP, EEG or NIRS measures of neurological complications prior to decannulation. No study-related adverse events or neuro-monitoring data interpreting issues were experienced.CONCLUSION: Non-invasive neuro-monitoring (SSEP/EEG/NIRS) during ECMO is feasible and may provide early indication of neurological complications in this high-risk population.

KW - Somatosensory evoked potential

KW - electroencephalography

KW - extracorporeal membrane oxygenation

KW - near infrared spectroscopy

KW - neuro-monitoring

KW - neurological injury

KW - prognostication

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Feasibility of non-invasive neuro-monitoring during extracorporeal membrane oxygenation in children

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

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