PMID- 35814786
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220716
IS  - 2296-858X (Print)
IS  - 2296-858X (Electronic)
IS  - 2296-858X (Linking)
VI  - 9
DP  - 2022
TI  - A Standardized Multimodal Neurological Monitoring Protocol-Guided Cerebral 
      Protection Therapy for Venoarterial Extracorporeal Membrane Oxygenation Supported 
      Patients.
PG  - 922355
LID - 10.3389/fmed.2022.922355 [doi]
LID - 922355
AB  - BACKGROUND: The main objective of this study was to investigate the role of a 
      multimodal neurological monitoring (MNM)-guided protocol in the precision 
      identification of neural impairment and long-term neurological outcomes in 
      venoarterial extracorporeal membrane oxygenation (VA-ECMO) supported patients. 
      METHODS: We performed a cohort study that examined adult patients who underwent 
      VA-ECMO support in our center between February 2010 and April 2021. These 
      patients were retrospectively assigned to the "with MNM group" and the "without 
      MNM group" based on the presence or absence of MNM-guided precision management. 
      The differences in ECMO-related characteristics, evaluation indicators 
      (precision, sensitivity, and specificity) of the MNM-guided protocol, and the 
      long-term outcomes of the surviving patients were measured and compared between 
      the two groups. RESULTS: A total of 63 patients with VA-ECMO support were 
      retrospectively assigned to the without MNM group (n = 35) and the with MNM group 
      (n = 28). The incidence of neural impairment in the without MNM group was 
      significantly higher than that in the with MNM group (82.1 vs. 54.3%, P = 0.020). 
      The MNM group exhibited older median ages [52.5 (39.5, 65.3) vs. 31 (26.5, 48.0), 
      P = 0.008], a higher success rate of ECMO weaning (92.8 vs. 71.4%, P = 0.047), 
      and a lower median duration of building ECMO [40.0 (35.0, 52.0) vs. 58.0 (48.0, 
      76.0), P = 0.025] and median ECMO duration days [5.0 (4.0, 6.2) vs. 7.0 (5.0, 
      10.5), P = 0.018] than the group without MNM. The MNM-guided protocol exhibited a 
      higher precision rate (82.1 vs. 60.0%), sensitivity (95.7 vs. 78.9%), and 
      specificity (83.3 vs. 37.5%) in identifying neural impairment in VA-ECMO support 
      patients. There were significant differences in the long-term outcomes of 
      survivors at 1, 3 and 6 months after discharge between the two groups (P < 0.05). 
      However, the results showed no significant differences in ICU length of stay 
      (LOS), hospital LOS, survival to discharge, or 28-day mortality between the two 
      groups (P > 0.05). CONCLUSION: The MNM-guided protocol is conducive to guiding 
      intensivists in the improvement of cerebral protection therapy for ECMO-supported 
      patients to detect and treat potential neurologic impairment promptly, and then 
      improving long-term neurological outcomes after discharge.
CI  - Copyright (c) 2022 Shi, Gu, Li, Diao, Wen, Hu and Xi.
FAU - Shi, Xiaobei
AU  - Shi X
AD  - Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang 
      University School of Medicine, Hangzhou, China.
FAU - Gu, Qiao
AU  - Gu Q
AD  - Department of Critical Care Medicine, Affiliated Hangzhou First People's 
      Hospital, Zhejiang University School of Medicine, Hangzhou, China.
FAU - Li, Yiwei
AU  - Li Y
AD  - Department of Critical Care Medicine, Affiliated Hangzhou First People's 
      Hospital, Zhejiang University School of Medicine, Hangzhou, China.
FAU - Diao, Mengyuan
AU  - Diao M
AD  - Department of Critical Care Medicine, Affiliated Hangzhou First People's 
      Hospital, Zhejiang University School of Medicine, Hangzhou, China.
FAU - Wen, Xin
AU  - Wen X
AD  - Department of Critical Care Medicine, Affiliated Hangzhou First People's 
      Hospital, Zhejiang University School of Medicine, Hangzhou, China.
FAU - Hu, Wei
AU  - Hu W
AD  - Department of Critical Care Medicine, Affiliated Hangzhou First People's 
      Hospital, Zhejiang University School of Medicine, Hangzhou, China.
FAU - Xi, Shaosong
AU  - Xi S
AD  - Department of Critical Care Medicine, Affiliated Hangzhou First People's 
      Hospital, Zhejiang University School of Medicine, Hangzhou, China.
LA  - eng
PT  - Journal Article
DEP - 20220623
PL  - Switzerland
TA  - Front Med (Lausanne)
JT  - Frontiers in medicine
JID - 101648047
PMC - PMC9261463
OTO - NOTNLM
OT  - VA-ECMO
OT  - long-term outcomes
OT  - multimodal neurological monitoring
OT  - neurologic impairment
OT  - protocol
COIS- The authors declare that the research was conducted in the absence of any 
      commercial or financial relationships that could be construed as a potential 
      conflict of interest.
EDAT- 2022/07/12 06:00
MHDA- 2022/07/12 06:01
PMCR- 2022/06/23
CRDT- 2022/07/11 04:22
PHST- 2022/04/17 00:00 [received]
PHST- 2022/05/17 00:00 [accepted]
PHST- 2022/07/11 04:22 [entrez]
PHST- 2022/07/12 06:00 [pubmed]
PHST- 2022/07/12 06:01 [medline]
PHST- 2022/06/23 00:00 [pmc-release]
AID - 10.3389/fmed.2022.922355 [doi]
PST - epublish
SO  - Front Med (Lausanne). 2022 Jun 23;9:922355. doi: 10.3389/fmed.2022.922355. 
      eCollection 2022.