PMID- 38510614
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240322
IS  - 2772-5294 (Electronic)
IS  - 2772-5294 (Linking)
VI  - 4
DP  - 2024
TI  - Changes in autonomic function and cerebral and somatic oxygenation with arterial 
      flow pulsatility for children requiring veno-arterial extracorporeal membrane 
      oxygenation.
PG  - 102731
LID - 10.1016/j.bas.2023.102731 [doi]
LID - 102731
AB  - BACKGROUND: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) carries 
      variability in arterial flow pulsatility (AFP). RESEARCH QUESTION: What changes 
      in cerebral and somatic oxygenation, hemodynamics, and autonomic function are 
      associated with AFP during VA-ECMO? METHODS: This is a prospective study of 
      children on VA-ECMO undergoing neuromonitoring. AFP was quantified by arterial 
      blood pressure pulse amplitude and subcategorized: no pulsatility (<1 mmHg), 
      minimal pulsatility (1 to <5 mmHg), moderate pulsatility (5 to <15 mmHg) and high 
      pulsatility (>/=15 mmHg). CVPR was assessed using the cerebral oximetry index 
      (COx). Cerebral and somatic oxygenation was assessed using cerebral regional 
      oximetry (rSO(2)) or peripheral oxygen saturation (SpO(2)). Autonomic function 
      was assessed using baroreflex sensitivity (BRs), low-frequency high-frequency 
      (LF/HF) ratio and standard deviation of heart rate R-R intervals (HRsd). 
      Differences were assessed across AFP categories using linear mixed effects models 
      with Tukey pairwise comparisons. Univariate logistic regression was used to 
      explore risk of AFP with brain injuries. RESULTS: Among fifty-three children, 
      comparisons of moderate to high pulsatility were associated with reductions in 
      rSO(2) (p < 0.001), SpO 2 (p = 0.005), LF/HF ratio (p = 0.028) and an increase in 
      HRsd (p < 0.001). Reductions in BRs were observed across comparisons of none to 
      minimal (P < 0.001) and minimal to moderate pulsatility (p = 0.004). Comparisons 
      of no to low pulsatility were associated with reductions in BRs (p < 0.001) and 
      ABP (p < 0.001) with increases in SpO(2) (p < 0.001) and HR (p < 0.001). Arterial 
      ischemic stroke was associated with higher pulsatility (p = 0.0384). CONCLUSION: 
      During VA-ECMO support, changes toward high AFP are associated with autonomic 
      dysregulation and compromised cerebral and somatic tissue oxygenation.
CI  - (c) 2023 The Authors.
FAU - Appavu, Brian
AU  - Appavu B
AD  - Barrow Neurological Institute at Phoenix Children's Hospital, Department of 
      Neurosciences, 1919 E. Thomas Road, Ambulatory Building B, 4th Floor, Phoenix, 
      AZ, 85016, USA.
FAU - Dunning, Elise
AU  - Dunning E
AD  - Creighton University Health Sciences Campus - Phoenix, 3100 N Central Avenue, 
      Phoenix, AZ, 85012, USA.
FAU - Hildebrandt, Kara
AU  - Hildebrandt K
AD  - Barrow Neurological Institute at Phoenix Children's Hospital, Department of 
      Neurosciences, 1919 E. Thomas Road, Ambulatory Building B, 4th Floor, Phoenix, 
      AZ, 85016, USA.
FAU - Hanalioglu, Damla
AU  - Hanalioglu D
AD  - Barrow Neurological Institute at Phoenix Children's Hospital, Department of 
      Neurosciences, 1919 E. Thomas Road, Ambulatory Building B, 4th Floor, Phoenix, 
      AZ, 85016, USA.
FAU - Abruzzo, Todd
AU  - Abruzzo T
AD  - Phoenix Children's Hospital, Department of Radiology, 1919 E. Thomas Road, 
      Phoenix, AZ, 85016, USA.
LA  - eng
PT  - Journal Article
DEP - 20231214
PL  - Netherlands
TA  - Brain Spine
JT  - Brain & spine
JID - 9918470888906676
PMC - PMC10951706
OTO - NOTNLM
OT  - Arterial flow pulsatility
OT  - Autonomic function
OT  - Cerebral regional oximetry
OT  - Cerebrovascular impedance
OT  - Cerebrovascular pressure reactivity
OT  - Extracorporeal membrane oxygenation
COIS- The authors declare that they have no known competing financial interests or 
      personal relationships that could have appeared to influence the work reported in 
      this paper. Brian Appavu, MD reports financial support was provided by 
      10.13039/100000968American Heart Association. Brian Appavu, MD reports a 
      relationship with Natus Medical Inc that includes: speaking and lecture fees. Dr. 
      Appavu is also an editorial board member for the journal, Neurocritical Care. Dr. 
      Appavu also reports a completed research grant from Moberg ICU Solutions as well 
      as a research grant from the 10.13039/100000005United States Department of 
      Defense 10.13039/100000090Congressionally Directed Medical Research Programs 
      Epilepsy Research Program (W81XWH-19-1-0514), both outside the scope of this 
      work.
EDAT- 2024/03/21 06:43
MHDA- 2024/03/21 06:44
PMCR- 2023/12/14
CRDT- 2024/03/21 04:13
PHST- 2023/06/14 00:00 [received]
PHST- 2023/12/01 00:00 [revised]
PHST- 2023/12/08 00:00 [accepted]
PHST- 2024/03/21 06:44 [medline]
PHST- 2024/03/21 06:43 [pubmed]
PHST- 2024/03/21 04:13 [entrez]
PHST- 2023/12/14 00:00 [pmc-release]
AID - S2772-5294(23)01019-6 [pii]
AID - 102731 [pii]
AID - 10.1016/j.bas.2023.102731 [doi]
PST - epublish
SO  - Brain Spine. 2023 Dec 14;4:102731. doi: 10.1016/j.bas.2023.102731. eCollection 
      2024.