title: Neuromonitoring During Extracorporeal Membrane Oxygenation: A Systematic Review of the Literature.
abstract: OBJECTIVE
  Neurologic injury remains a significant morbidity and risk factor for mortality in critically ill patients undergoing extracorporeal membrane oxygenation. Our goal was to systematically review the literature on the use of neuromonitoring methods during extracorporeal membrane oxygenation.
  
  
  METHODS
  Electronic searches of PubMed, CINAHL, EMBASE, Web of Science, Cochrane, and Scopus were conducted in March 2014, using a combination of medical subject heading terms and text words to define concepts of extracorporeal life support, neurologic monitoring techniques, evaluation, and outcomes.
  
  
  METHODS
  Studies were selected based on inclusion and exclusion criteria defined a priori.
  
  
  METHODS
  Two authors reviewed all citations independently. A standardized data extraction form was used to construct evidence tables by neuromonitoring method. Evidence was graded using the Oxford Evidence-Based Medicine scoring system.
  
  
  RESULTS
  Of 3,459 unique citations, 39 studies met the inclusion criteria. Study designs were retrospective observational cohort studies (n = 20), prospective observational studies (n = 17), case-control studies (n = 2), and no interventional studies. Most studies evaluated newborns (n = 30). Extracorporeal membrane oxygenation neuromonitoring methods included neuroimaging (head ultrasound) (n = 12); intermittent, conventional, multichannel electroencephalography (n = 5); 1- to 2-channel amplitude-integrated electroencephalography (n = 2); Doppler ultrasound (n = 7); cerebral oximetry (n = 6); plasma brain injury biomarkers (n = 4); and other (n = 3). All evidence was graded 2B-4, with the majority of studies graded 3B (20/39 studies) and 4 (10/39 studies). Due to the heterogeneity of the studies included, aggregate analysis was not possible.
  
  
  CONCLUSIONS
  Data supporting the use and effectiveness of current neuromonitoring methods are limited. Most studies have modest sample sizes, are observational in nature, and include patient populations that are of different ages and pathologies, with very limited data for pediatric and adult ages. Well-designed studies with adequate power and standardized short- and long-term outcomes are needed to develop guidelines for neuromonitoring and ultimately neuroprotection in patients on extracorporeal membrane oxygenation.
authors.affiliation: 1Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD. 2Department of Neurology, Johns Hopkins University, Baltimore, MD. 3William H. Welch Medical Library, Baltimore, MD. 4Kennedy Krieger Institute, Baltimore, MD. 5Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD. 6Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD.
authors.forename: Melania M
authors.initials: MM
authors.lastname: Bembea
authors.forename: Ryan
authors.initials: R
authors.lastname: Felling
authors.forename: Blair
authors.initials: B
authors.lastname: Anton
authors.forename: Cynthia F
authors.initials: CF
authors.lastname: Salorio
authors.forename: Michael V
authors.initials: MV
authors.lastname: Johnston
mesh_terms: D015415:Biomarkers / Q000097:blood; D001930:Brain Injuries / Q000097:blood; D004569:Electroencephalography; D015199:Extracorporeal Membrane Oxygenation; D006801:Humans; D059906:Neuroimaging; D064926:Neurophysiological Monitoring / Q000379:methods*; D010092:Oximetry; D018608:Ultrasonography, Doppler
chemical_list: D015415:Biomarkers