Cerebral Autoregulation: A Target for Improving Neurological Outcomes in Extracorporeal Life Support.
Cardiopulmonary resuscitation
Cerebral hemorrhage
Cerebrovascular circulation
Extracorporeal membrane oxygenation
Intracranial pressure
Stroke
Journal
Neurocritical care
ISSN: 1556-0961
Titre abrégé: Neurocrit Care
Pays: United States
ID NLM: 101156086
Informations de publication
Date de publication:
29 May 2024
29 May 2024
Historique:
received:
05
01
2024
accepted:
18
04
2024
medline:
30
5
2024
pubmed:
30
5
2024
entrez:
29
5
2024
Statut:
aheadofprint
Résumé
Despite improvements in survival after illnesses requiring extracorporeal life support, cerebral injury continues to hinder successful outcomes. Cerebral autoregulation (CA) is an innate protective mechanism that maintains constant cerebral blood flow in the face of varying systemic blood pressure. However, it is impaired in certain disease states and, potentially, following initiation of extracorporeal circulatory support. In this review, we first discuss patient-related factors pertaining to venovenous and venoarterial extracorporeal membrane oxygenation (ECMO) and their potential role in CA impairment. Next, we examine factors intrinsic to ECMO that may affect CA, such as cannulation, changes in pulsatility, the inflammatory and adaptive immune response, intracranial hemorrhage, and ischemic stroke, in addition to ECMO management factors, such as oxygenation, ventilation, flow rates, and blood pressure management. We highlight potential mechanisms that lead to disruption of CA in both pediatric and adult populations, the challenges of measuring CA in these patients, and potential associations with neurological outcome. Altogether, we discuss individualized CA monitoring as a potential target for improving neurological outcomes in extracorporeal life support.
Identifiants
pubmed: 38811513
doi: 10.1007/s12028-024-02002-5
pii: 10.1007/s12028-024-02002-5
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania
ID : Institute for Translational Medicine and Therapeutics Tuition Award
Informations de copyright
© 2024. The Author(s).
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