Electroencephalographic features in patients undergoing extracorporeal membrane oxygenation
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RESEARCH
Electroencephalographic features in patients undergoing extracorporeal membrane oxygenation Lorenzo Peluso1* , Serena Rechichi1,2, Federico Franchi1,2, Selene Pozzebon1,2, Sabino Scolletta2, Alexandre Brasseur1, Benjamin Legros3, Jean‑Louis Vincent1, Jacques Creteur1, Nicolas Gaspard3,4† and Fabio Silvio Taccone1†
Abstract Background: Neurologic injury is one of the most frequent causes of death in patients undergoing extracorporeal membrane oxygenation (ECMO). As neurological examination is often unreliable in sedated patients, additional neu‑ romonitoring is needed. However, the value of electroencephalogram (EEG) in adult ECMO patients has not been well assessed. Therefore, the aim of this study was to assess the occurrence of electroencephalographic abnormalities in patients treated with extracorporeal membrane oxygenation (ECMO) and their association with 3-month neurologic outcome. Methods: Retrospective analysis of all patients undergoing venous–venous (V–V) or venous–arterial (V–A) ECMO with a concomitant EEG recording (April 2009–December 2018), either recorded intermittently or continuously. EEG background was classified into four categories: mild/moderate encephalopathy (i.e., mostly defined by the pres‑ ence of reactivity), severe encephalopathy (mostly defined by the absence of reactivity), burst-suppression (BS) and suppressed background. Epileptiform activity (i.e., ictal EEG pattern, sporadic epileptiform discharges or periodic discharges) and asymmetry were also reported. EEG findings were analyzed according to unfavorable neurological outcome (UO, defined as Glasgow Outcome Scale 65–70 mmHg using volume resuscitation, noradrenaline and/or dobutamine, whenever needed, or by adjusting the ECMO blood flow in veno-arterial (V-A) configuration. Blood flow, FiO2 and gas flow of the ECMO were adapted to maintain PaO2 between 60 and 150 mmHg and P aCO2 between 35 and 45 mmHg, with a prior adaptation of the ventilator for a protective ventilation associated to the lowest FiO2. Blood glucose was kept between 110 and 150 mg/dl using continuous insulin infusion. Enteral nutrition was initiated as soon as possible and continued thereafter according to gastric tolerance. Management of ECMO is reported in Additional file 1. Data collection and definition
We collected data on demographics, comorbidities, indications and duration of ECMO support, as well as ICU length of stay and hospital mortality. We also collected Glasgow Coma Score during ECMO and major complications during ECMO therapy (i.e., cerebral ischemic stroke; intracranial hemorrhage—ICH), brain death, major bleeding, i.e., reduction of at least 2 g/dL in hemoglobin levels requiring ≥ 4 RBC units to be transfused over 24 h), ECMO configuration, the use of red blood cells transfusions (RBCT), sedative, analgesic and/or antiepileptic drugs. Also, the results from brain imaging were collected, whenever available during the entire ICU stay. We also recorded mechanical ventilation settings
Peluso et al. Crit Care
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