Bembea Melania M, Felling Ryan, Anton Blair, Salorio Cynthia F, Johnston Michael V
1Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD. 2Department of Neurology, Johns Hopkins University, Baltimore, MD. 3William H. Welch Medical Library, Baltimore, MD. 4Kennedy Krieger Institute, Baltimore, MD. 5Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD. 6Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD.
Pediatr Crit Care Med. 2015 Jul;16(6):558-64. doi: 10.1097/PCC.0000000000000415.
Neurologic injury remains a significant morbidity and risk factor for mortality in critically ill patients undergoing extracorporeal membrane oxygenation. Our goal was to systematically review the literature on the use of neuromonitoring methods during extracorporeal membrane oxygenation.
Electronic searches of PubMed, CINAHL, EMBASE, Web of Science, Cochrane, and Scopus were conducted in March 2014, using a combination of medical subject heading terms and text words to define concepts of extracorporeal life support, neurologic monitoring techniques, evaluation, and outcomes.
Studies were selected based on inclusion and exclusion criteria defined a priori.
Two authors reviewed all citations independently. A standardized data extraction form was used to construct evidence tables by neuromonitoring method. Evidence was graded using the Oxford Evidence-Based Medicine scoring system.
Of 3,459 unique citations, 39 studies met the inclusion criteria. Study designs were retrospective observational cohort studies (n = 20), prospective observational studies (n = 17), case-control studies (n = 2), and no interventional studies. Most studies evaluated newborns (n = 30). Extracorporeal membrane oxygenation neuromonitoring methods included neuroimaging (head ultrasound) (n = 12); intermittent, conventional, multichannel electroencephalography (n = 5); 1- to 2-channel amplitude-integrated electroencephalography (n = 2); Doppler ultrasound (n = 7); cerebral oximetry (n = 6); plasma brain injury biomarkers (n = 4); and other (n = 3). All evidence was graded 2B-4, with the majority of studies graded 3B (20/39 studies) and 4 (10/39 studies). Due to the heterogeneity of the studies included, aggregate analysis was not possible.
Data supporting the use and effectiveness of current neuromonitoring methods are limited. Most studies have modest sample sizes, are observational in nature, and include patient populations that are of different ages and pathologies, with very limited data for pediatric and adult ages. Well-designed studies with adequate power and standardized short- and long-term outcomes are needed to develop guidelines for neuromonitoring and ultimately neuroprotection in patients on extracorporeal membrane oxygenation.
在接受体外膜肺氧合治疗的重症患者中，神经损伤仍然是导致显著发病率和死亡风险的因素。我们的目标是系统回顾有关体外膜肺氧合期间神经监测方法应用的文献。
2014年3月，对PubMed、CINAHL、EMBASE、科学网、Cochrane和Scopus进行了电子检索，使用医学主题词和文本词的组合来定义体外生命支持、神经监测技术、评估和结果等概念。
根据事先定义的纳入和排除标准选择研究。
两位作者独立审查所有文献。使用标准化的数据提取表，按神经监测方法构建证据表。采用牛津循证医学评分系统对证据进行分级。
在3459篇独特的文献中，39项研究符合纳入标准。研究设计包括回顾性观察队列研究（n = 20）、前瞻性观察研究（n = 17）、病例对照研究（n = 2），无干预性研究。大多数研究评估的是新生儿（n = 30）。体外膜肺氧合神经监测方法包括神经影像学检查（头部超声）（n = 12）；间歇性、传统多通道脑电图检查（n = 5）；1至2通道振幅整合脑电图检查（n = 2）；多普勒超声检查（n = 7）；脑氧饱和度测定（n = 6）；血浆脑损伤生物标志物检测（n = 4）；以及其他（n = 3）。所有证据的分级为2B - 4级，大多数研究分级为3B（20/39项研究）和4级（10/39项研究）。由于纳入研究的异质性，无法进行汇总分析。
支持当前神经监测方法的使用及其有效性的数据有限。大多数研究样本量适中，本质上属于观察性研究，且纳入的患者群体年龄和病理情况各异，儿科和成人的数据非常有限。需要设计完善、具有足够效力且有标准化短期和长期结果的研究，以制定体外膜肺氧合患者神经监测及最终神经保护的指南。
