Cerebral Blood Flow Hemispheric Asymmetry in Comatose Adults Receiving Extracorporeal Membrane Oxygenation
Peripheral veno-arterial extracorporeal membrane oxygenation (ECMO) artificially oxygenates and circulates blood retrograde from the femoral artery, potentially exposing the brain to asymmetric perfusion. Though ECMO patients frequently experience brain injury, neurologic exams and imaging are diffi...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-04-01
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| Series: | Frontiers in Neuroscience |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fnins.2022.858404/full |
| _version_ | 1819023261934026752 |
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| author | Thomas W. Johnson Irfaan A. Dar Kelly L. Donohue Yama Y. Xu Esmeralda Santiago Olga Selioutski Mark A. Marinescu Ross K. Maddox Ross K. Maddox Tong Tong Wu Giovanni Schifitto Igor Gosev Regine Choe Regine Choe Imad R. Khan |
| author_facet | Thomas W. Johnson Irfaan A. Dar Kelly L. Donohue Yama Y. Xu Esmeralda Santiago Olga Selioutski Mark A. Marinescu Ross K. Maddox Ross K. Maddox Tong Tong Wu Giovanni Schifitto Igor Gosev Regine Choe Regine Choe Imad R. Khan |
| author_sort | Thomas W. Johnson |
| collection | DOAJ |
| description | Peripheral veno-arterial extracorporeal membrane oxygenation (ECMO) artificially oxygenates and circulates blood retrograde from the femoral artery, potentially exposing the brain to asymmetric perfusion. Though ECMO patients frequently experience brain injury, neurologic exams and imaging are difficult to obtain. Diffuse correlation spectroscopy (DCS) non-invasively measures relative cerebral blood flow (rBF) at the bedside using an optical probe on each side of the forehead. In this study we observed interhemispheric rBF differences in response to mean arterial pressure (MAP) changes in adult ECMO recipients. We recruited 13 subjects aged 21–78 years (7 with cardiac arrest, 4 with acute heart failure, and 2 with acute respiratory distress syndrome). They were dichotomized via Glasgow Coma Scale Motor score (GCS-M) into comatose (GCS-M ≤ 4; n = 4) and non-comatose (GCS-M > 4; n = 9) groups. Comatose patients had greater interhemispheric rBF asymmetry (ASYMrBF) vs. non-comatose patients over a range of MAP values (29 vs. 11%, p = 0.009). ASYMrBF in comatose patients resolved near a MAP range of 70–80 mmHg, while rBF remained symmetric through a wider MAP range in non-comatose patients. Correlations between post-oxygenator pCO2 or pH vs. ASYMrBF were significantly different between comatose and non-comatose groups. Our findings indicate that comatose patients are more likely to have asymmetric cerebral perfusion. |
| first_indexed | 2024-12-21T04:36:05Z |
| format | Article |
| id | doaj.art-448d7b82d5a449cfa8af1e8d58f56c58 |
| institution | Directory Open Access Journal |
| issn | 1662-453X |
| language | English |
| last_indexed | 2024-12-21T04:36:05Z |
| publishDate | 2022-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neuroscience |
| spelling | doaj.art-448d7b82d5a449cfa8af1e8d58f56c582022-12-21T19:15:51ZengFrontiers Media S.A.Frontiers in Neuroscience1662-453X2022-04-011610.3389/fnins.2022.858404858404Cerebral Blood Flow Hemispheric Asymmetry in Comatose Adults Receiving Extracorporeal Membrane OxygenationThomas W. Johnson0Irfaan A. Dar1Kelly L. Donohue2Yama Y. Xu3Esmeralda Santiago4Olga Selioutski5Mark A. Marinescu6Ross K. Maddox7Ross K. Maddox8Tong Tong Wu9Giovanni Schifitto10Igor Gosev11Regine Choe12Regine Choe13Imad R. Khan14Department of Neurology, University of Rochester Medical Center, Rochester, NY, United StatesDepartment of Biomedical Engineering, University of Rochester, Rochester, NY, United StatesDepartment of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United StatesSchool of Arts and Sciences, University of Rochester, Rochester, NY, United StatesSchool of Arts and Sciences, University of Rochester, Rochester, NY, United StatesDepartment of Neurology, University of Rochester Medical Center, Rochester, NY, United StatesDepartment of Medicine, University of Rochester Medical Center, Rochester, NY, United StatesDepartment of Biomedical Engineering, University of Rochester, Rochester, NY, United StatesDepartment of Neuroscience, University of Rochester Medical Center, Rochester, NY, United StatesDepartment of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, United StatesDepartment of Neurology, University of Rochester Medical Center, Rochester, NY, United StatesDivision of Cardiac Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY, United StatesDepartment of Biomedical Engineering, University of Rochester, Rochester, NY, United StatesDepartment of Electrical and Computer Engineering, University of Rochester, Rochester, NY, United StatesDepartment of Neurology, University of Rochester Medical Center, Rochester, NY, United StatesPeripheral veno-arterial extracorporeal membrane oxygenation (ECMO) artificially oxygenates and circulates blood retrograde from the femoral artery, potentially exposing the brain to asymmetric perfusion. Though ECMO patients frequently experience brain injury, neurologic exams and imaging are difficult to obtain. Diffuse correlation spectroscopy (DCS) non-invasively measures relative cerebral blood flow (rBF) at the bedside using an optical probe on each side of the forehead. In this study we observed interhemispheric rBF differences in response to mean arterial pressure (MAP) changes in adult ECMO recipients. We recruited 13 subjects aged 21–78 years (7 with cardiac arrest, 4 with acute heart failure, and 2 with acute respiratory distress syndrome). They were dichotomized via Glasgow Coma Scale Motor score (GCS-M) into comatose (GCS-M ≤ 4; n = 4) and non-comatose (GCS-M > 4; n = 9) groups. Comatose patients had greater interhemispheric rBF asymmetry (ASYMrBF) vs. non-comatose patients over a range of MAP values (29 vs. 11%, p = 0.009). ASYMrBF in comatose patients resolved near a MAP range of 70–80 mmHg, while rBF remained symmetric through a wider MAP range in non-comatose patients. Correlations between post-oxygenator pCO2 or pH vs. ASYMrBF were significantly different between comatose and non-comatose groups. Our findings indicate that comatose patients are more likely to have asymmetric cerebral perfusion.https://www.frontiersin.org/articles/10.3389/fnins.2022.858404/fullcerebrovascular autoregulationcomadiffuse correlation spectroscopyextracorporeal membrane oxygenationcerebral blood flow |
| spellingShingle | Thomas W. Johnson Irfaan A. Dar Kelly L. Donohue Yama Y. Xu Esmeralda Santiago Olga Selioutski Mark A. Marinescu Ross K. Maddox Ross K. Maddox Tong Tong Wu Giovanni Schifitto Igor Gosev Regine Choe Regine Choe Imad R. Khan Cerebral Blood Flow Hemispheric Asymmetry in Comatose Adults Receiving Extracorporeal Membrane Oxygenation Frontiers in Neuroscience cerebrovascular autoregulation coma diffuse correlation spectroscopy extracorporeal membrane oxygenation cerebral blood flow |
| title | Cerebral Blood Flow Hemispheric Asymmetry in Comatose Adults Receiving Extracorporeal Membrane Oxygenation |
| title_full | Cerebral Blood Flow Hemispheric Asymmetry in Comatose Adults Receiving Extracorporeal Membrane Oxygenation |
| title_fullStr | Cerebral Blood Flow Hemispheric Asymmetry in Comatose Adults Receiving Extracorporeal Membrane Oxygenation |
| title_full_unstemmed | Cerebral Blood Flow Hemispheric Asymmetry in Comatose Adults Receiving Extracorporeal Membrane Oxygenation |
| title_short | Cerebral Blood Flow Hemispheric Asymmetry in Comatose Adults Receiving Extracorporeal Membrane Oxygenation |
| title_sort | cerebral blood flow hemispheric asymmetry in comatose adults receiving extracorporeal membrane oxygenation |
| topic | cerebrovascular autoregulation coma diffuse correlation spectroscopy extracorporeal membrane oxygenation cerebral blood flow |
| url | https://www.frontiersin.org/articles/10.3389/fnins.2022.858404/full |
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