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- Open Access
Cerebral Autoregulation in Patients Treated With V-Vecmo For Severe Ards
© Fanelli et al.; 2015
- Published: 1 October 2015
- Cystic Fibrosis
- Mean Arterial Pressure
- Brain Death
- Extracorporeal Membrane Oxygenation
In patients with severe ARDS refractory to conventional mechanical ventilation, venous-venous extracorporeal membrane oxygenation (v-vECMO) is a rescue therapy able to restore normal values of PaO2 and PaCO2, maintaining the lung at rest. Hypoxemia and hypercapnia occurring in patients with severe ARDS may negatively affect cerebral autoregulation.
The hypothesis of the present study was that, in patients with severe ARDS, impaired cerebral autoregulation due to gas exchange derangement, may be restored by application of v-vECMO.
Clinical prospective observational study. Inclusion criteria: severe ARDS (P/F ≤ 100), requiring v-vECMO. Exclusion criteria: previous diagnosed neurological diseases. the following parameters were recorded before (pre) and after institution of v-vECMO (post): mean arterial pressure (MAP), cerebral blood flow velocity in middle cerebral artery (MCA FV) by transcranial Doppler, and alveolar gas exchange (PaCO2, PaO2). Cerebral autoregulation was assessed by Pearson linear regression coefficient (Mx index) between MCA FV and MAP during spontaneous fluctuations of MAP (cut-off of Mx ≥ 0.2 was adopted to define impaired autoregulation).
Physiological data before and after ECMO.
MCA Flow Velocity (cm/sec) - PRE
MCA Flow Velocity (cm/sec) - POST
Mx - PRE
Mx - POST
PaO2 (mmHg) - PRE
PaO2 (mmHg) - POST
PaCO2 (mmHg) - PRE
PaCO2 (mmHg) - POST
Patient 4 evolved to brain death on day 1 and was then excluded.
Paired t-test was used for analysis. MAP was 82 ± 9 and 94 ± 17, pre and post ECMO respectively. Mx significantly changed from 0.41 ± 0.2 to 0.13 ± 0.16 (p = 0.009); both PaO2 and PaCO2 significantly improved (p = 0.05).
In patients with severe ARDS our preliminary data suggest that v-vECMO is able to restore cerebral autoregulation that is impaired because of severe gas exchange derangement.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.