Extracorporeal Membrane Oxygenation Complication
Conditions
Keywords
neurologic complication, transcranial Doppler ultrasound
Brief summary
To determine how venoarterial extracorporeal membrane oxygenation (ECMO) affects cerebral blood flow velocity (CBFV) measured by transcranial doppler (TCD), to determine whether specific changes in cerebral blood flow velocity may be associated with neurologic injury and to determine modifications of CBFV after withdrawal of ECMO.
Detailed description
Venoarterial Extracorporeal membrane oxygenation (ECMO) is used in adult with refractory cardiac failure as a life-saving measure. Adults treated with ECMO survived to hospital discharge in 21,8% to 65,4% of cases. Neurologic complications such as intracranial hemorrhage, anoxia and ischemia are major causes of death and long-term disability in ECMO patients (7% to 14%). Current neurological monitoring techniques are insufficient to predict which critically ill patient receiving ECMO therapy will suffer from neurologic injury. Even after a clinical suspicion of neurologic injury, diagnosis can be difficult. TCD is commonly used to monitor the CBFV of traumatic brain injury. There are no reports that evaluate CBFV of patients requiring ECMO therapy. Patient will have to do both echocardiography and TCD to evaluate cardiac output and CBFV. We will repeat these dopplers every 24 hours until ECMO withdrawal and one day after explantation.
Interventions
OTHERExamination : a TCD and Trans-Thoracic Echocardiography
Examination that involves the completion of a TCD and an TTE (Trans-Thoracic Echocardiography) : * To reports clinical parameters at the time of the examination : ECG data: sinus rhythm, atrial or ventricular arrhythmia, state of consciousness, heart rate, O2 saturation * To review of pharmacological parameters at the time of the examination : presence of sedation; presence, type and dose of catecholamines. * To collect biological data from the day of the examination : Partial Pressure of O2, PaCO2 (partial pressure) and hematocrit * To collect possible additional examinations : brain scan, EEG. These are non-invasive exams that do not require patient displacement. Only the samples taken by the medical team as part of the treatment will be analyzed.
Sponsors
University Hospital, Toulouse
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
PREVENTION
Masking
NONE
Intervention model description
Patient treated with Venoarterial Extracorporeal membrane oxygenation (ECMO) Realization of transcranial doppler (TCD) of the right and left middle cerebral artery in the first 48 hours of the setting up of the ECMO with joint realization of an Trans-thoracic echocardiography (TTE) then every 24 hours until the end of the using of the ECMO and the realization of TCD and TTE during the 24 hours after removal of the ECMO.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* adult patient who receiving ECMO therapy
Exclusion criteria
* cervico-encephalic vasculopathy * lacked an acoustic window allowing for adequate TCD examination * stroke in medical past.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Cerebral blood flow velocities evolution | 24 hours | Cerebral blood flow velocities evolution over the time |
| The correlation of Cerebral blood flow velocities with the variation of the cardiac output and ECMO flow. | 24 hours | The correlation with the variation of the cardiac output and ECMO flow. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Relation between acute neurologic injury and variation of CBFV | 24 hours | Relation between acute neurologic injury and variation of CBFV detected by TCD. |
| Modification of the CBFV detected by TCD after the withdrawal of the ECMO. | 24 hours | Modification of the cerebral blood flow velocity (CBFV) detected by TCD after the withdrawal of the ECMO. |
| Relation between the CBFV, the NIRS, the cardiac flow and the ECMO flow. | 24 hours | Relation between the CBFV (cerebral blood flow velocity), the Near Infrared Spectroscopy (NIRS), the cardiac flow and the ECMO flow. |
Countries
France
Contacts
Primary ContactFanny BOUNES, MD
Backup ContactIsabelle OLIVIER, PhD
Outcome results
None listed