Background:

Adverse neurological events during extracorporeal membrane oxygenation (ECMO) are common and may be associated with devastating consequences. Close monitoring, early identification and prompt intervention can mitigate early and late neurological morbidity. Neuromonitoring and neurocognitive/neurodevelopmental follow-up are critically important to optimize outcomes in both adults and children.

Objective:

To assess current practice of neuromonitoring during ECMO and neurocognitive/neurodevelopmental follow-up after ECMO across Europe and to inform the development of neuromonitoring and follow-up guidelines.

Methods:

The EuroELSO Neurological Monitoring and Outcome Working Group conducted an electronic, web-based, multi-institutional, multinational survey in Europe.

Results:

Of the 211 European ECMO centres (including non-ELSO centres) identified and approached in 23 countries, 133 (63%) responded. Of these, 43% reported routine neuromonitoring during ECMO for all patients, 35% indicated selective use, and 22% practiced bedside clinical examination alone. The reported neuromonitoring modalities were NIRS (n = 88, 66.2%), electroencephalography (n = 52, 39.1%), transcranial Doppler (n = 38, 28.5%) and brain injury biomarkers (n = 33, 24.8%). Paediatric centres (67%) reported using cranial ultrasound, though the frequency of monitoring varied widely. Before hospital discharge following ECMO, 50 (37.6%) reported routine neurological assessment and 22 (16.5%) routinely performed neuroimaging with more paediatric centres offering neurological assessment (65%) as compared to adult centres (20%). Only 15 (11.2%) had a structured longitudinal follow-up pathway (defined followup at regular intervals), while 99 (74.4%) had no follow-up programme. The majority (n = 96, 72.2%) agreed that there should be a longitudinal structured follow-up for ECMO survivors.

Conclusions:

This survey demonstrated significant variability in the use of different neuromonitoring modalities during and after ECMO. The perceived importance of neuromonitoring and follow-up was noted to be very high with agreement for a longitudinal structured follow-up programme, particularly in paediatric patients. Scientific society endorsed guidelines and minimum standards should be developed to inform local protocols.

中文翻译：

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欧洲体外膜氧合支持的儿童和成人神经监测和神经发育结果的国际调查

背景：

体外膜肺氧合 (ECMO) 期间的不良神经系统事件很常见，并且可能与破坏性后果有关。密切监测、早期识别和及时干预可以减轻早期和晚期神经系统疾病的发病率。神经监测和神经认知/神经发育随访对于优化成人和儿童的结果至关重要。

客观的：

评估欧洲 ECMO 期间神经监测和 ECMO 后神经认知/神经发育随访的当前实践，并为神经监测和随访指南的制定提供信息。

方法：

EuroELSO 神经学监测和结果工作组在欧洲进行了一项基于网络的电子多机构跨国调查。

结果：

在 23 个国家确定并接洽的 211 个欧洲 ECMO 中心（包括非 ELSO 中心）中，有 133 个（63%）做出了回应。其中，43% 报告所有患者在 ECMO 期间进行常规神经监测，35% 表示选择性使用，22% 仅进行床边临床检查。报告的神经监测方式是 NIRS ( n = 88, 66.2%)、脑电图 ( n = 52, 39.1%)、经颅多普勒 ( n = 38, 28.5%) 和脑损伤生物标志物 ( n= 33, 24.8%)。儿科中心 (67%) 报告使用颅脑超声，但监测频率差异很大。在 ECMO 后出院前，50 名 (37.6%) 报告了常规神经系统评估，22 名 (16.5%) 常规进行了神经影像学检查，与成人中心 (20%) 相比，更多儿科中心提供神经系统评估 (65%)。只有 15 名 (11.2%) 有结构化的纵向随访路径（确定的定期随访），而 99 名 (74.4%) 没有随访计划。大多数人 ( n = 96, 72.2%) 同意应该对 ECMO 幸存者进行纵向结构化随访。

结论：

这项调查表明，在 ECMO 期间和之后使用不同的神经监测方式存在显着差异。神经监测和随访的重要性被认为非常高，并同意纵向结构化随访计划，特别是在儿科患者中。应制定科学协会认可的指导方针和最低标准，以告知地方规程。