Department of Biomedical Engineering, University of Rochester, Rochester, New York, United States of America.
Department of Neurology, University of Rochester Medical Center, Rochester, New York, United States of America.
PLoS One. 2024 Oct 29;19(10):e0299752. doi: 10.1371/journal.pone.0299752. eCollection 2024.
Adult patients who have suffered acute cardiac or pulmonary failure are increasingly being treated using extracorporeal membrane oxygenation (ECMO), a cardiopulmonary bypass technique. While ECMO has improved the long-term outcomes of these patients, neurological injuries can occur from underlying illness or ECMO itself. Cerebral autoregulation (CA) allows the brain to maintain steady perfusion during changes in systemic blood pressure. Dysfunctional CA is a marker of acute brain injury and can worsen neurologic damage. Monitoring CA using invasive modalities can be risky in ECMO patients due to the necessity of anticoagulation therapy. Diffuse correlation spectroscopy (DCS) measures cerebral blood flow continuously, noninvasively, at the bedside, and can monitor CA. In this study, we compare DCS-based markers of CA in veno-arterial ECMO patients with and without acute brain injury.
Adults undergoing ECMO were prospectively enrolled at a single tertiary hospital and underwent DCS and arterial blood pressure monitoring during ECMO. Neurologic injuries were identified using brain computerized tomography (CT) scans obtained in all patients. CA was calculated over a twenty-minute window via wavelet coherence analysis (WCA) over 0.05 Hz to 0.1 Hz and a Pearson correlation (DCSx) between cerebral blood flow measured by DCS and mean arterial pressure.
Eleven ECMO patients who received CT neuroimaging were recruited. 5 (45%) patients were found to have neurologic injury. CA indices WCOH, the area under the curve of the WCA, were significantly higher for patients with neurological injuries compared to those without neurological injuries (right hemisphere p = 0.041, left hemisphere p = 0.041). %DCSx, percentage of time DCSx was above a threshold 0.4, were not significantly higher (right hemisphere p = 0.268, left hemisphere p = 0.073).
DCS can be used to detect differences in CA for ECMO patients with neurological injuries compared to uninjured patients using WCA.
越来越多患有急性心脏或肺部衰竭的成年患者正在接受体外膜氧合（ECMO）治疗，这是一种心肺旁路技术。虽然 ECMO 改善了这些患者的长期预后，但潜在疾病或 ECMO 本身可导致神经损伤。脑自动调节（CA）可使大脑在全身血压变化时保持稳定的灌注。CA 功能障碍是急性脑损伤的标志物，并可加重神经损伤。由于需要抗凝治疗，使用侵入性方式监测 ECMO 患者的 CA 可能存在风险。漫反射相关光谱（DCS）通过床边连续、无创的方式测量脑血流，可以监测 CA。在这项研究中，我们比较了伴有和不伴有急性脑损伤的静脉动脉 ECMO 患者的基于 DCS 的 CA 标志物。
在一家三级医院前瞻性纳入接受 ECMO 的成年人，并在 ECMO 期间进行 DCS 和动脉血压监测。通过对所有患者进行脑计算机断层扫描（CT）扫描来确定神经损伤。通过小波相干分析（WCA）在 0.05 Hz 至 0.1 Hz 之间计算 20 分钟窗口内的 CA，并通过 DCS 测量的脑血流与平均动脉压之间的 Pearson 相关（DCSx）计算 CA。
共纳入 11 例接受 CT 神经影像学检查的 ECMO 患者。5（45%）例患者发现有神经损伤。与无神经损伤患者相比，有神经损伤患者的 CA 指数 WCOH、WCA 的曲线下面积显著更高（右侧半球 p = 0.041，左侧半球 p = 0.041）。DCSx%，DCSx 超过 0.4 的阈值的时间百分比，没有明显更高（右侧半球 p = 0.268，左侧半球 p = 0.073）。
与未受损患者相比，WCA 可使用 DCS 检测有神经损伤的 ECMO 患者 CA 差异。
