Correlations Between Quantitative EEG Parameters and Cortical Blood Flow in Patients Undergoing Extracorporeal Membrane Oxygenation With and Without Encephalopathy.
Journal
Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society
ISSN: 1537-1603
Titre abrégé: J Clin Neurophysiol
Pays: United States
ID NLM: 8506708
Informations de publication
Date de publication:
30 Oct 2023
30 Oct 2023
Historique:
medline:
7
11
2023
pubmed:
7
11
2023
entrez:
7
11
2023
Statut:
aheadofprint
Résumé
The neurologic examination of patients undergoing extracorporeal membrane oxygenation (ECMO) is crucial for evaluating irreversible encephalopathy but is often obscured by sedation or neuromuscular blockade. Noninvasive neuromonitoring modalities including diffuse correlation spectroscopy and EEG measure cerebral perfusion and neuronal function, respectively. We hypothesized that encephalopathic ECMO patients with greater degree of irreversible cerebral injury demonstrate less correlation between electrographic activity and cerebral perfusion than those whose encephalopathy is attributable to medications. We performed a prospective observational study of adults undergoing ECMO who underwent simultaneous continuous EEG and diffuse correlation spectroscopy monitoring. (Alpha + beta)/delta ratio and alpha/delta Rartio derived from quantitative EEG analysis were correlated with frontal cortical blood flow index. Patients who awakened and followed commands during sedation pauses were included in group 1, whereas patients who could not follow commands for most neuromonitoring were placed in group 2. (Alpha + beta)/delta ratio-blood flow index and ADR-BFI correlations were compared between the groups. Ten patients (five in each group) underwent 39 concomitant continuous EEG and diffuse correlation spectroscopy monitoring sessions. Four patients (80%) in each group received some form of analgosedation during neuromonitoring. (Alpha + beta)/delta ratio-blood flow index correlation was significantly lower in group 2 than group 1 (left: 0.05 vs. 0.52, P = 0.03; right: -0.12 vs. 0.39, P = 0.04). Group 2 ADR-BFI correlation was lower only over the right hemisphere (-0.06 vs. 0.47, P = 0.04). Correlation between (alpha + beta)/delta ratio and blood flow index were decreased in encephalopathic ECMO patients compared with awake ones, regardless of the analgosedation use. The combined use of EEG and diffuse correlation spectroscopy may have utility in monitoring cerebral function in ECMO patients.
Identifiants
pubmed: 37934074
doi: 10.1097/WNP.0000000000001035
pii: 00004691-990000000-00108
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : University of Rochester
ID : University Research Award
Informations de copyright
Copyright © 2023 by the American Clinical Neurophysiology Society.
Déclaration de conflit d'intérêts
I. R. Khan reports grants from the National Institute of Neurologic Disorders and Stroke, National Heart, Lung, and Blood Institute, and the Department of Defense; G. Schifitto report grants from the National Institute of Neurologic Disorders and Stroke; D. R. Busch reports grants from The Hartwell Foundation, National Institute of Neurologic Disorders and Stroke, and National Institute of Biomedical Imaging and Bioengineering. D. R. Busch has patents on aspects of DCS technologies. These patents are not licensed and produce no revenue. D. R. Busch has equity interest in NFOSYS, a startup seeking to commercialize minimally invasive DCS tools, which currently has no sales and no revenue; R. Choe reports grants from the National Institute of Arthritis and Musculoskeletal and Skin Diseases; and R. K. Maddox reports grants from the National Institute on Deafness and Other Communication Disorders, all during the conduct of this study. I. Gosev received consulting and personal fees from Abbott, ABIOMED, and Zimmer Biomet Holdings, outside the scope of this work. The remaining authors have no funding or conflicts of interest to disclose.
Références
Shoskes A, Migdady I, Rice C, et al. Brain injury is more common in venoarterial extracorporeal membrane oxygenation than venovenous extracorporeal membrane oxygenation: a systematic review and meta-analysis. Crit Care Med 2020;48:1799–1808.
Lorusso R, Barili F, Mauro MD, et al. In-hospital neurologic complications in adult patients undergoing venoarterial extracorporeal membrane oxygenation: results from the extracorporeal life support organization registry. Crit Care Med 2016;44:e964–e972.
Marhong JD, DeBacker J, Viau-Lapointe J, et al. Sedation and mobilization during venovenous extracorporeal membrane oxygenation for acute respiratory failure: an international survey. Crit Care Med 2017;45:1893–1899.
Dar IA, Khan IR, Maddox RK, et al. Towards detection of brain injury using multimodal non-invasive neuromonitoring in adults undergoing extracorporeal membrane oxygenation. Biomed Opt Express 2020;11:6551–6569.
Mesquita RC, Durduran T, Yu G, et al. Direct measurement of tissue blood flow and metabolism with diffuse optics. Philos Trans R Soc A Math Phys Eng Sci 2011;369:4390–4406.
Buckley EM, Hance D, Pawlowski T, et al. Validation of diffuse correlation spectroscopic measurement of cerebral blood flow using phase-encoded velocity mapping magnetic resonance imaging. J Biomed Opt 2012;17:037007.
Jain V, Buckley EM, Licht DJ, et al. Cerebral oxygen metabolism in neonates with congenital heart disease quantified by MRI and optics. J Cereb Blood Flow Metab 2014;34:380–388.
Yu G, Floyd TF, Durduran T, et al. Validation of diffuse correlation spectroscopy for muscle blood flow with concurrent arterial spin labeled perfusion MRI. Opt Express 2007;15:1064–1075.
Durduran T, Zhou C, Edlow BL, et al. Transcranial optical monitoring of cerebrovascular hemodynamics in acute stroke patients. Opt Express 2009;17:3884–3902.
Kim MN, Durduran T, Frangos S, et al. Noninvasive measurement of cerebral blood flow and blood oxygenation using near-infrared and diffuse correlation spectroscopies in critically brain-injured adults. Neurocrit Care 2010;12:173–180.
Buckley EM, Lynch JM, Goff DA, et al. Early postoperative changes in cerebral oxygen metabolism following neonatal cardiac surgery: effects of surgical duration. J Thorac Cardiovasc Surg 2013;145:196–205.e1; discussion 203–205.
Durduran T, Yodh AG. Diffuse correlation spectroscopy for non-invasive, micro-vascular cerebral blood flow measurement. Neuroimage 2014;85:51–63.
Delgado-Mederos R, Gregori-Pla C, Zirak P, et al. Transcranial diffuse optical assessment of the microvascular reperfusion after thrombolysis for acute ischemic stroke. Biomed Opt Express 2018;9:1262–1271.
Johnson TW, Dar IA, Donohue KL, et al. Cerebral blood flow hemispheric asymmetry in comatose adults receiving extracorporeal membrane oxygenation. Front Neurosci 2022;16:858404.
Kirschstein T, Kohling R. What is the source of the EEG? Clin EEG Neurosci 2009;40:146–149.
Das Y, Leon RL, Liu H, et al. Wavelet-based neurovascular coupling can predict brain abnormalities in neonatal encephalopathy. Neuroimage Clin 2021;32:102856.
Iadecola C. The neurovascular unit coming of age: a journey through neurovascular coupling in health and disease. Neuron 2017;96:17–42.
van den Brule JMD, van der Hoeven JG, Hoedemaekers CWE. Cerebral perfusion and cerebral autoregulation after cardiac arrest. Biomed Res Int 2018;2018:1–5.
Mullaguri N, Sarwal A, Katyal N, Nattanamai P, George P, Newey CR. Trans-cranial Doppler as an ancillary study supporting irreversible brain injury in a post cardiac arrest patient on extracorporeal membrane oxygenation. Cureus 2018;10:e2161.
Herman ST, Abend NS, Bleck TP, et al. Consensus statement on continuous EEG in critically ill adults and children, part II: personnel, technical specifications, and clinical practice. J Clin Neurophysiol 2015;32:96–108.
Selioutski O, Auinger P, Siddiqi OK, Michael BD, Buback C, Birbeck GL. Association of the verbal component of the GCS with mortality in patients with encephalopathy who are not undergoing mechanical ventilation. Neurology 2022;98:e533–e540.
Lee YH, Oh YT, Ahn HC, et al. The prognostic value of the grey-to-white matter ratio in cardiac arrest patients treated with extracorporeal membrane oxygenation. Resuscitation 2016;99:50–55.
Dankiewicz J, Cronberg T, Lilja G, et al. Hypothermia versus normothermia after out-of-hospital cardiac arrest. N Engl J Med 2021;384:2283–2294.
Cummins RO, Chamberlain DA, Abramson NS, et al. Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein Style. A statement for health professionals from a task force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council. Circulation 1991;84:960–975.
Wiley SL, Razavi B, Krishnamohan P, et al. Quantitative EEG metrics differ between outcome groups and change over the first 72 h in comatose cardiac arrest patients. Neurocrit Care 2018;28:51–59.
Yu Z, Wen D, Zheng J, et al. Predictive accuracy of alpha-delta ratio on quantitative electroencephalography for delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage: meta-analysis. World Neurosurg 2019;126:e510–e516.
Ebersole JS, Pedley TA. Current practice of clinical electroencephalography. London, United Kingdom: Lippincott Williams & Wilkins, 2003.
Tatum WO IV. Handbook of EEG interpretation. 3rd ed. New York: Demos Medical, 2021; 568.
Fisch BJ. Fisch and Spehlmann's EEG primer: basic principles of digital and analog EEG. 3rd ed. Amsterdam: Elsevier, 1999.
Barr J, Fraser GL, Puntillo K, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med 2013;41:263–306.
Burcham PK, Rozycki AJ, Abel EE. Considerations for analgosedation and antithrombotic management during extracorporeal life support. Ann Transl Med 2017;5:69.
Madsen PL, Vorstrup S. Cerebral blood flow and metabolism during sleep. Cerebrovasc Brain Metab Rev 1991;3:281–296.
Foreman B, Claassen J. Quantitative EEG for the detection of brain ischemia. Crit Care 2012;16:216.
Gottlibe M, Rosen O, Weller B, et al. Stroke identification using a portable EEG device—a pilot study. Neurophysiol Clin 2020;50:21–25.
Girouard H, Iadecola C. Neurovascular coupling in the normal brain and in hypertension, stroke, and Alzheimer disease. J Appl Physiol 2006;100:328–335.
Bundo M, Inao S, Nakamura A, et al. Changes of neural activity correlate with the severity of cortical ischemia in patients with unilateral major cerebral artery occlusion. Stroke 2002;33:61–66.
Dietrich WD, Ginsberg MD, Busto R. Effect of transient cerebral ischemia on metabolic activation of a somatosensory circuit. J Cereb Blood Flow Metab 1986;6:405–413.
Laurikkala J, Aneman A, Peng A, et al. Association of deranged cerebrovascular reactivity with brain injury following cardiac arrest: a post-hoc analysis of the COMACARE trial. Crit Care 2021;25:350.
Smith A, Morgan C, Ledot S, et al. Veno-venous extracorporeal membrane oxygenation for the acute respiratory distress syndrome: a bridge too far? Acta Cardiol 2021;76:455–458.
DeFilippis EM, Clerkin K, Truby LK, et al. ECMO as a bridge to left ventricular assist device or heart transplantation. JACC Heart Fail 2021;9:281–289.
Chocron R, Fahrenbruch C, Yin L, et al. Association between functional status at hospital discharge and long-term survival after out-of-hospital-cardiac-arrest. Resuscitation 2021;164:30–37.
Sekhon MS, Gooderham P, Menon DK, et al. The burden of brain hypoxia and optimal mean arterial pressure in patients with hypoxic ischemic brain injury after cardiac arrest. Crit Care Med 2019;47:960–969.
Veraar CM, Rinosl H, Kuhn K, et al. Non-pulsatile blood flow is associated with enhanced cerebrovascular carbon dioxide reactivity and an attenuated relationship between cerebral blood flow and regional brain oxygenation. Crit Care 2019;23:426.
Laman DM, Wieneke GH, van Duijn H, Veldhuizen RJ, van Huffelen AC. QEEG changes during carotid clamping in carotid endarterectomy: spectral edge frequency parameters and relative band power parameters. J Clin Neurophysiol 2005;22:244–252.
Ong BA, Geocadin R, Choi CW, Whitman G, Cho SM. Brain magnetic resonance imaging in adult survivors of extracorporeal membrane oxygenation. Perfusion 2021;36:814–824.
Dragojevic T, Hollmann JL, Tamborini D, et al. Compact, multi-exposure speckle contrast optical spectroscopy (SCOS) device for measuring deep tissue blood flow. Biomed Opt Express 2018;9:322–334.
Baker WB, Parthasarathy AB, Ko TS, et al. Pressure modulation algorithm to separate cerebral hemodynamic signals from extracerebral artifacts. Neurophotonics 2015;2:035004.
Irwin D, Dong L, Shang Y, et al. Influences of tissue absorption and scattering on diffuse correlation spectroscopy blood flow measurements. Biomed Opt Express 2011;2:1969–1985.