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
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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Auteurs

Nolan Chalifoux (N)

Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA. nolanchalifoux94@gmail.com.
Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA. nolanchalifoux94@gmail.com.
Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA. nolanchalifoux94@gmail.com.

Tiffany Ko (T)

Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.

Julia Slovis (J)

Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.

Audrey Spelde (A)

Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.

Todd Kilbaugh (T)

Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.

Constantine D Mavroudis (CD)

Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA.

Classifications MeSH