Cerebral Autoregulation: A Target for Improving Neurological Outcomes in Extracorporeal Life Support

Despite improvements in survival after illnesses requiring extracorporeal life support, cerebral injury continues to hinder successful outcomes. Cerebral autoregulation (CA) is an innate protective mechanism that maintains constant cerebral blood flow in the face of varying systemic blood pressure....

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Bibliographic Details
Published in:Neurocritical care 2024-12, Vol.41 (3), p.1055-1072
Main Authors: Chalifoux, Nolan, Ko, Tiffany, Slovis, Julia, Spelde, Audrey, Kilbaugh, Todd, Mavroudis, Constantine D.
Format: Article
Language:English
Subjects:
Cerebrovascular Circulation - physiology
Critical Care Medicine
Extracorporeal membrane oxygenation
Extracorporeal Membrane Oxygenation - methods
Heart surgery
Homeostasis - physiology
Humans
Intensive
Internal Medicine
Intracranial pressure
Medicine
Medicine & Public Health
Metabolism
Neurology
Neurosurgery
Nitric oxide
Pediatrics
Physiology
Respiratory failure
Review
Review Article
Traumatic brain injury
Veins & arteries
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Summary:Despite improvements in survival after illnesses requiring extracorporeal life support, cerebral injury continues to hinder successful outcomes. Cerebral autoregulation (CA) is an innate protective mechanism that maintains constant cerebral blood flow in the face of varying systemic blood pressure. However, it is impaired in certain disease states and, potentially, following initiation of extracorporeal circulatory support. In this review, we first discuss patient-related factors pertaining to venovenous and venoarterial extracorporeal membrane oxygenation (ECMO) and their potential role in CA impairment. Next, we examine factors intrinsic to ECMO that may affect CA, such as cannulation, changes in pulsatility, the inflammatory and adaptive immune response, intracranial hemorrhage, and ischemic stroke, in addition to ECMO management factors, such as oxygenation, ventilation, flow rates, and blood pressure management. We highlight potential mechanisms that lead to disruption of CA in both pediatric and adult populations, the challenges of measuring CA in these patients, and potential associations with neurological outcome. Altogether, we discuss individualized CA monitoring as a potential target for improving neurological outcomes in extracorporeal life support.
ISSN:1541-6933
1556-0961
1556-0961
DOI:10.1007/s12028-024-02002-5