What are the most common neurologic complications associated with VA ECMO, and How to Improve Outcomes
VA ECMO (Veno-Arterial Extracorporeal Membrane Oxygenation) is a life-support technique used to assist adults suffering from severe cardiogenic shock caused by various conditions such as myocardial infarction, pulmonary embolism, drug overdose, and refractory cardiac arrest. Despite advancements in ECMO technology and care, up to 60% of patients on VA ECMO experience complications.
One of the most severe issues is neurologic complications, which affect approximately 21% of VA ECMO patients. These complications include ischemic stroke, intracranial hemorrhage (ICH), and hypoxic-ischemic brain injury (HIBI).
To improve outcomes, standardized neuromonitoring protocols should be implemented. These protocols include regular neurologic examinations, transcranial Doppler (TCD), electroencephalography (EEG), and neuroimaging. Such protocols can lead to more frequent and accurate diagnoses and better patient outcomes. Additionally, measuring neuron-specific enolase levels and using cerebral near-infrared spectroscopy (NIRS) can help in the early detection and management of acute brain injuries.
Another unique complication of peripheral VA ECMO is differential hypoxemia, which occurs in about 9% of patients. This condition can lead to inadequate oxygen supply to the heart and brain. Management strategies for differential hypoxemia include increasing ECMO blood flow, adjusting ventilator settings, and potentially converting to central cannulation.
By understanding and addressing these complications, healthcare providers can significantly improve the care and outcomes for patients undergoing VA ECMO.
Today's trivia Thursday content is sourced from "Complications, Followup, and Outcomes of Adults with Cardiac Failure" by Hannah Rando, Sung-Min Cho, Daniele Camboni, and Michael Mazzeffi, as mentioned in Chapter 33 of ELSO Red Book 6th Edition.
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Note: This article reflects my learning journey in ECMO and is intended for educational purposes only. It should not be used as a substitute for professional medical advice or guidance. Always consult with qualified healthcare professionals for clinical decisions and patient care.
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Acknowledgments:
I developed three custom GPTs, “AI ECMO Expert,” “ECMO Specialist Handover Practice,” and “Micro Definitions (MD-GPT),” for specialized research. These tools draw primarily from the ELSO Redbook (6th Edition), the ELSO Specialist Training Manual (4th Edition), various research papers, and articles. Additional research was supported by GPT-4o/o1, Claude 3.5 Sonnet/Opus, and Perplexity. Editing was performed with Grammarly. A.I. images and charts were created using Leonardo AI, DALL-E3 AI Image Generator, Microsoft Designer, and Adobe Express. Content for all articles sourced from Extracorporeal Life Support: The ELSO Red Book, 6th Edition, and ECMO Specialist Training Manual, 4th Edition.