Early detection of neurologic injury and issues of rehabilitation after pediatric cardiac extracorporeal membrane oxygenation.
Neurological impairment results in a significant population of children after extracorporeal membrane oxygenation (ECMO) for treatment of otherwise intractable circulatory failure. Pre-ECMO hypoxia/ischemia, reperfusion injury, and impaired cerebral perfusion during low output situations possibly aggravated by harmful effects of a pulsatile perfusion are discussed in terms of possible etiological reasons. To develop preventive strategies or to enable curative measure, early detection of neuronal injury seems mandatory. Electroencephalographic surveillance and/or monitoring of evoked potentials and monitoring of cerebral oxygenation by means of near infrared spectroscopy or jugular venous bulb oxygen saturation, as well as measurements of serum neuron specific enolase, S-100 protein, and brain type creatine kinase can be employed clinically. To improve functional outcome following neuronal injury, early rehabilitation seems essential to minimize the resulting effects on physical, cognitive, and emotional development.
Golej
J
J
Department of Neonatology and Pediatric Intensive Care, University Children's Hospital of Vienna, Austria.
Trittenwein
G
G
D001921:Brain / Q000201:enzymology / Q000378:metabolism; D001925:Brain Damage, Chronic / Q000175:diagnosis* / Q000517:prevention & control / Q000534:rehabilitation; D002303:Cardiac Output, Low / Q000150:complications; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000517:prevention & control / Q000534:rehabilitation; D002648:Child; D002657:Child Development; D003402:Creatine Kinase / Q000032:analysis; D004569:Electroencephalography; D005071:Evoked Potentials / Q000502:physiology; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000175:diagnosis / Q000517:prevention & control / Q000534:rehabilitation; D007601:Jugular Veins; D008991:Monitoring, Physiologic; D010101:Oxygen Consumption / Q000502:physiology; D010751:Phosphopyruvate Hydratase / Q000097:blood; D015427:Reperfusion Injury / Q000175:diagnosis / Q000517:prevention & control / Q000534:rehabilitation; D009418:S100 Proteins / Q000097:blood; D019265:Spectroscopy, Near-Infrared
D009418:S100 Proteins; D003402:Creatine Kinase; D010751:Phosphopyruvate Hydratase