PMID- 36167950 OWN - NLM STAT- MEDLINE DCOM- 20230607 LR - 20230817 IS - 1556-0961 (Electronic) IS - 1541-6933 (Print) IS - 1541-6933 (Linking) VI - 38 IP - 3 DP - 2023 Jun TI - Early Low Pulse Pressure in VA-ECMO Is Associated with Acute Brain Injury. PG - 612-621 LID - 10.1007/s12028-022-01607-y [doi] AB - BACKGROUND: Pulse pressure is a dynamic marker of cardiovascular function and is often impaired in patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO). Pulsatile blood flow also serves as a regulator of vascular endothelium, and continuous-flow mechanical circulatory support can lead to endothelial dysfunction. We explored the impact of early low pulse pressure on occurrence of acute brain injury (ABI) in VA-ECMO. METHODS: We conducted a retrospective analysis of adults with VA-ECMO at a tertiary care center between July 2016 and January 2021. Patients underwent standardized multimodal neuromonitoring throughout ECMO support. ABI included intracranial hemorrhage, ischemic stroke, hypoxic ischemic brain injury, cerebral edema, seizure, and brain death. Blood pressures were recorded every 15 min. Low pulse pressure was defined as a median pulse pressure < 20 mm Hg in the first 12 h of ECMO. Multivariable logistic regression was performed to investigate the association between pulse pressure and ABI. RESULTS: We analyzed 5138 blood pressure measurements from 123 (median age 63; 63% male) VA-ECMO patients (54% peripheral; 46% central cannulation), of whom 41 (33%) experienced ABI. Individual ABIs were as follows: ischemic stroke (n = 18, 15%), hypoxic ischemic brain injury (n = 14, 11%), seizure (n = 8, 7%), intracranial hemorrhage (n = 7, 6%), cerebral edema (n = 7, 6%), and brain death (n = 2, 2%). Fifty-eight (47%) patients had low pulse pressure. In a multivariable model adjusting for preselected covariates, including cannulation strategy (central vs. peripheral), lactate on ECMO day 1, and left ventricle venting strategy, low pulse pressure was independently associated with ABI (adjusted odds ratio 2.57, 95% confidence interval 1.05-6.24). In a model with the same covariates, every 10-mm Hg decrease in pulse pressure was associated with 31% increased odds of ABI (95% confidence interval 1.01-1.68). In a sensitivity analysis model adjusting for systolic pressure, pulse pressure remained significantly associated with ABI. CONCLUSIONS: Early low pulse pressure (< 20 mm Hg) was associated with ABI in VA-ECMO patients. Low pulse pressure may serve as a marker of ABI risk, which necessitates close neuromonitoring for early detection. CI - (c) 2022. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society. FAU - Shou, Benjamin L AU - Shou BL AUID- ORCID: 0000-0003-2825-3301 AD - Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, 1800 Orleans St, Zayed 7107, Baltimore, MD, 21287, USA. bshou1@jhmi.edu. FAU - Wilcox, Christopher AU - Wilcox C AD - Division of Neurosciences Critical Care, Department of Neurology, Neurosurgery, Anesthesiology, Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD, USA. FAU - Florissi, Isabella AU - Florissi I AD - Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, 1800 Orleans St, Zayed 7107, Baltimore, MD, 21287, USA. FAU - Kalra, Andrew AU - Kalra A AD - Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, 1800 Orleans St, Zayed 7107, Baltimore, MD, 21287, USA. FAU - Caturegli, Giorgio AU - Caturegli G AD - Division of Neurosciences Critical Care, Department of Neurology, Neurosurgery, Anesthesiology, Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD, USA. FAU - Zhang, Lucy Q AU - Zhang LQ AD - Division of Neurosciences Critical Care, Department of Neurology, Neurosurgery, Anesthesiology, Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD, USA. FAU - Bush, Errol AU - Bush E AD - Division of General Thoracic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA. FAU - Kim, Bo AU - Kim B AD - Division of Pulmonary and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD, USA. FAU - Keller, Steven P AU - Keller SP AD - Division of Pulmonary and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD, USA. FAU - Whitman, Glenn J R AU - Whitman GJR AD - Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, 1800 Orleans St, Zayed 7107, Baltimore, MD, 21287, USA. FAU - Cho, Sung-Min AU - Cho SM AD - Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, 1800 Orleans St, Zayed 7107, Baltimore, MD, 21287, USA. AD - Division of Neurosciences Critical Care, Department of Neurology, Neurosurgery, Anesthesiology, Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD, USA. CN - HERALD Investigators LA - eng GR - K08 HL143342/HL/NHLBI NIH HHS/United States GR - K23 HL157610/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20220927 PL - United States TA - Neurocrit Care JT - Neurocritical care JID - 101156086 SB - IM MH - Adult MH - Humans MH - Male MH - Middle Aged MH - Female MH - Retrospective Studies MH - *Extracorporeal Membrane Oxygenation MH - Blood Pressure MH - Brain Death MH - *Brain Edema MH - Seizures MH - Intracranial Hemorrhages/etiology/therapy MH - *Brain Injuries MH - *Ischemic Stroke PMC - PMC10040467 MID - NIHMS1839549 OTO - NOTNLM OT - Acute brain injury OT - Extracorporeal membrane oxygenation OT - Neurological complication OT - Pulsatility OT - Pulse pressure FIR - Calligy, Kate IR - Calligy K FIR - Brown, Patricia IR - Brown P FIR - Alejo, Diane IR - Alejo D FIR - Anderson, Scott IR - Anderson S FIR - Acton, Matthew IR - Acton M FIR - Rando, Hannah IR - Rando H FIR - Chang, Henry IR - Chang H FIR - Kerr, Hannah IR - Kerr H EDAT- 2022/09/29 06:00 MHDA- 2023/06/07 06:42 PMCR- 2023/06/08 CRDT- 2022/09/28 00:04 PHST- 2022/06/10 00:00 [received] PHST- 2022/09/06 00:00 [accepted] PHST- 2023/06/07 06:42 [medline] PHST- 2022/09/29 06:00 [pubmed] PHST- 2022/09/28 00:04 [entrez] PHST- 2023/06/08 00:00 [pmc-release] AID - 10.1007/s12028-022-01607-y [pii] AID - 10.1007/s12028-022-01607-y [doi] PST - ppublish SO - Neurocrit Care. 2023 Jun;38(3):612-621. doi: 10.1007/s12028-022-01607-y. Epub 2022 Sep 27.