Early Low Pulse Pressure in VA-ECMO Is Associated with Acute Brain Injury
Background Pulse pressure is a dynamic marker of cardiovascular function and is often impaired in patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO). Pulsatile blood flow also serves as a regulator of vascular endothelium, and continuous-flow mechanical circulatory support can le...
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| Veröffentlicht in: | Neurocritical care 2023-06, Vol.38 (3), p.612-621 |
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| creator | Shou, Benjamin L. Wilcox, Christopher Florissi, Isabella Kalra, Andrew Caturegli, Giorgio Zhang, Lucy Q. Bush, Errol Kim, Bo Keller, Steven P. Whitman, Glenn J. R. Cho, Sung-Min |
| description | Background
Pulse pressure is a dynamic marker of cardiovascular function and is often impaired in patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO). Pulsatile blood flow also serves as a regulator of vascular endothelium, and continuous-flow mechanical circulatory support can lead to endothelial dysfunction. We explored the impact of early low pulse pressure on occurrence of acute brain injury (ABI) in VA-ECMO.
Methods
We conducted a retrospective analysis of adults with VA-ECMO at a tertiary care center between July 2016 and January 2021. Patients underwent standardized multimodal neuromonitoring throughout ECMO support. ABI included intracranial hemorrhage, ischemic stroke, hypoxic ischemic brain injury, cerebral edema, seizure, and brain death. Blood pressures were recorded every 15 min. Low pulse pressure was defined as a median pulse pressure |
| doi_str_mv | 10.1007/s12028-022-01607-y |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10040467</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2919507951</sourcerecordid><originalsourceid>FETCH-LOGICAL-c475t-842b1fe15415eca8b07ec6bd04c3fcda505eff9206e2831f8487123119b8dd043</originalsourceid><addsrcrecordid>eNp9kUFv1DAQhS0EoqXwBzggS1y4GGac2E5OaFkt7UqL2kPhajnOpM0qmxQ7ocq_x8uWtnDoyZbmmzcz7zH2FuEjAphPESXIQoCUAlCDEfMzdoxKaQGlxuf7f45Cl1l2xF7FuAWQpjTqJTvKNGpTKjhm65UL3cw3wy2_mLpI_CJQjFMg3vb8x0Kslt_O-TryRYyDb91INb9tx2u-8NNI_EtwCVv32ynMr9mLxiWFN3fvCfv-dXW5PBOb89P1crERPjdqFEUuK2xov5oi74oKDHld1ZD7rPG1U6CoaUoJmmSRYVPkhUGZIZZVUScqO2GfD7o3U7Wj2lM_BtfZm9DuXJjt4Fr7b6Vvr-3V8Msmz3LItUkKH-4UwvBzojjaXRs9dZ3raZiilQaLUkuFe_T9f-h2mEKf7rOyxORgchETJQ-UD0OMgZr7bRD2Y409RGVTVPZPVHZOTe8e33Hf8jebBGQHIKZSf0XhYfYTsr8BM7ed7w</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2919507951</pqid></control><display><type>article</type><title>Early Low Pulse Pressure in VA-ECMO Is Associated with Acute Brain Injury</title><source>SpringerLink Journals - AutoHoldings</source><source>ProQuest Central</source><creator>Shou, Benjamin L. ; Wilcox, Christopher ; Florissi, Isabella ; Kalra, Andrew ; Caturegli, Giorgio ; Zhang, Lucy Q. ; Bush, Errol ; Kim, Bo ; Keller, Steven P. ; Whitman, Glenn J. R. ; Cho, Sung-Min</creator><creatorcontrib>Shou, Benjamin L. ; Wilcox, Christopher ; Florissi, Isabella ; Kalra, Andrew ; Caturegli, Giorgio ; Zhang, Lucy Q. ; Bush, Errol ; Kim, Bo ; Keller, Steven P. ; Whitman, Glenn J. R. ; Cho, Sung-Min ; HERALD Investigators ; the HERALD Investigators</creatorcontrib><description>Background
Pulse pressure is a dynamic marker of cardiovascular function and is often impaired in patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO). Pulsatile blood flow also serves as a regulator of vascular endothelium, and continuous-flow mechanical circulatory support can lead to endothelial dysfunction. We explored the impact of early low pulse pressure on occurrence of acute brain injury (ABI) in VA-ECMO.
Methods
We conducted a retrospective analysis of adults with VA-ECMO at a tertiary care center between July 2016 and January 2021. Patients underwent standardized multimodal neuromonitoring throughout ECMO support. ABI included intracranial hemorrhage, ischemic stroke, hypoxic ischemic brain injury, cerebral edema, seizure, and brain death. Blood pressures were recorded every 15 min. Low pulse pressure was defined as a median pulse pressure < 20 mm Hg in the first 12 h of ECMO. Multivariable logistic regression was performed to investigate the association between pulse pressure and ABI.
Results
We analyzed 5138 blood pressure measurements from 123 (median age 63; 63% male) VA-ECMO patients (54% peripheral; 46% central cannulation), of whom 41 (33%) experienced ABI. Individual ABIs were as follows: ischemic stroke (
n
= 18, 15%), hypoxic ischemic brain injury (
n
= 14, 11%), seizure (
n
= 8, 7%), intracranial hemorrhage (
n
= 7, 6%), cerebral edema (
n
= 7, 6%), and brain death (
n
= 2, 2%). Fifty-eight (47%) patients had low pulse pressure. In a multivariable model adjusting for preselected covariates, including cannulation strategy (central vs. peripheral), lactate on ECMO day 1, and left ventricle venting strategy, low pulse pressure was independently associated with ABI (adjusted odds ratio 2.57, 95% confidence interval 1.05–6.24). In a model with the same covariates, every 10-mm Hg decrease in pulse pressure was associated with 31% increased odds of ABI (95% confidence interval 1.01–1.68). In a sensitivity analysis model adjusting for systolic pressure, pulse pressure remained significantly associated with ABI.
Conclusions
Early low pulse pressure (< 20 mm Hg) was associated with ABI in VA-ECMO patients. Low pulse pressure may serve as a marker of ABI risk, which necessitates close neuromonitoring for early detection.</description><identifier>ISSN: 1541-6933</identifier><identifier>EISSN: 1556-0961</identifier><identifier>DOI: 10.1007/s12028-022-01607-y</identifier><identifier>PMID: 36167950</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Blood pressure ; Brain death ; Critical care ; Critical Care Medicine ; Edema ; Electronic health records ; Extracorporeal membrane oxygenation ; Heart failure ; Hypoxia ; Intensive ; Intensive care ; Internal Medicine ; Ischemia ; Medical records ; Medicine ; Medicine & Public Health ; Mortality ; Neurology ; Neurosurgery ; Original Work ; Patients ; Stroke ; Tomography ; Traumatic brain injury ; Variables</subject><ispartof>Neurocritical care, 2023-06, Vol.38 (3), p.612-621</ispartof><rights>Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2022. Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2022. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c475t-842b1fe15415eca8b07ec6bd04c3fcda505eff9206e2831f8487123119b8dd043</citedby><cites>FETCH-LOGICAL-c475t-842b1fe15415eca8b07ec6bd04c3fcda505eff9206e2831f8487123119b8dd043</cites><orcidid>0000-0003-2825-3301</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s12028-022-01607-y$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2919507951?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>230,314,776,780,881,21367,27901,27902,33721,33722,41464,42533,43781,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36167950$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Shou, Benjamin L.</creatorcontrib><creatorcontrib>Wilcox, Christopher</creatorcontrib><creatorcontrib>Florissi, Isabella</creatorcontrib><creatorcontrib>Kalra, Andrew</creatorcontrib><creatorcontrib>Caturegli, Giorgio</creatorcontrib><creatorcontrib>Zhang, Lucy Q.</creatorcontrib><creatorcontrib>Bush, Errol</creatorcontrib><creatorcontrib>Kim, Bo</creatorcontrib><creatorcontrib>Keller, Steven P.</creatorcontrib><creatorcontrib>Whitman, Glenn J. R.</creatorcontrib><creatorcontrib>Cho, Sung-Min</creatorcontrib><creatorcontrib>HERALD Investigators</creatorcontrib><creatorcontrib>the HERALD Investigators</creatorcontrib><title>Early Low Pulse Pressure in VA-ECMO Is Associated with Acute Brain Injury</title><title>Neurocritical care</title><addtitle>Neurocrit Care</addtitle><addtitle>Neurocrit Care</addtitle><description>Background
Pulse pressure is a dynamic marker of cardiovascular function and is often impaired in patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO). Pulsatile blood flow also serves as a regulator of vascular endothelium, and continuous-flow mechanical circulatory support can lead to endothelial dysfunction. We explored the impact of early low pulse pressure on occurrence of acute brain injury (ABI) in VA-ECMO.
Methods
We conducted a retrospective analysis of adults with VA-ECMO at a tertiary care center between July 2016 and January 2021. Patients underwent standardized multimodal neuromonitoring throughout ECMO support. ABI included intracranial hemorrhage, ischemic stroke, hypoxic ischemic brain injury, cerebral edema, seizure, and brain death. Blood pressures were recorded every 15 min. Low pulse pressure was defined as a median pulse pressure < 20 mm Hg in the first 12 h of ECMO. Multivariable logistic regression was performed to investigate the association between pulse pressure and ABI.
Results
We analyzed 5138 blood pressure measurements from 123 (median age 63; 63% male) VA-ECMO patients (54% peripheral; 46% central cannulation), of whom 41 (33%) experienced ABI. Individual ABIs were as follows: ischemic stroke (
n
= 18, 15%), hypoxic ischemic brain injury (
n
= 14, 11%), seizure (
n
= 8, 7%), intracranial hemorrhage (
n
= 7, 6%), cerebral edema (
n
= 7, 6%), and brain death (
n
= 2, 2%). Fifty-eight (47%) patients had low pulse pressure. In a multivariable model adjusting for preselected covariates, including cannulation strategy (central vs. peripheral), lactate on ECMO day 1, and left ventricle venting strategy, low pulse pressure was independently associated with ABI (adjusted odds ratio 2.57, 95% confidence interval 1.05–6.24). In a model with the same covariates, every 10-mm Hg decrease in pulse pressure was associated with 31% increased odds of ABI (95% confidence interval 1.01–1.68). In a sensitivity analysis model adjusting for systolic pressure, pulse pressure remained significantly associated with ABI.
Conclusions
Early low pulse pressure (< 20 mm Hg) was associated with ABI in VA-ECMO patients. Low pulse pressure may serve as a marker of ABI risk, which necessitates close neuromonitoring for early detection.</description><subject>Blood pressure</subject><subject>Brain death</subject><subject>Critical care</subject><subject>Critical Care Medicine</subject><subject>Edema</subject><subject>Electronic health records</subject><subject>Extracorporeal membrane oxygenation</subject><subject>Heart failure</subject><subject>Hypoxia</subject><subject>Intensive</subject><subject>Intensive care</subject><subject>Internal Medicine</subject><subject>Ischemia</subject><subject>Medical records</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mortality</subject><subject>Neurology</subject><subject>Neurosurgery</subject><subject>Original Work</subject><subject>Patients</subject><subject>Stroke</subject><subject>Tomography</subject><subject>Traumatic brain injury</subject><subject>Variables</subject><issn>1541-6933</issn><issn>1556-0961</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>BENPR</sourceid><recordid>eNp9kUFv1DAQhS0EoqXwBzggS1y4GGac2E5OaFkt7UqL2kPhajnOpM0qmxQ7ocq_x8uWtnDoyZbmmzcz7zH2FuEjAphPESXIQoCUAlCDEfMzdoxKaQGlxuf7f45Cl1l2xF7FuAWQpjTqJTvKNGpTKjhm65UL3cw3wy2_mLpI_CJQjFMg3vb8x0Kslt_O-TryRYyDb91INb9tx2u-8NNI_EtwCVv32ynMr9mLxiWFN3fvCfv-dXW5PBOb89P1crERPjdqFEUuK2xov5oi74oKDHld1ZD7rPG1U6CoaUoJmmSRYVPkhUGZIZZVUScqO2GfD7o3U7Wj2lM_BtfZm9DuXJjt4Fr7b6Vvr-3V8Msmz3LItUkKH-4UwvBzojjaXRs9dZ3raZiilQaLUkuFe_T9f-h2mEKf7rOyxORgchETJQ-UD0OMgZr7bRD2Y409RGVTVPZPVHZOTe8e33Hf8jebBGQHIKZSf0XhYfYTsr8BM7ed7w</recordid><startdate>20230601</startdate><enddate>20230601</enddate><creator>Shou, Benjamin L.</creator><creator>Wilcox, Christopher</creator><creator>Florissi, Isabella</creator><creator>Kalra, Andrew</creator><creator>Caturegli, Giorgio</creator><creator>Zhang, Lucy Q.</creator><creator>Bush, Errol</creator><creator>Kim, Bo</creator><creator>Keller, Steven P.</creator><creator>Whitman, Glenn J. R.</creator><creator>Cho, Sung-Min</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-2825-3301</orcidid></search><sort><creationdate>20230601</creationdate><title>Early Low Pulse Pressure in VA-ECMO Is Associated with Acute Brain Injury</title><author>Shou, Benjamin L. ; Wilcox, Christopher ; Florissi, Isabella ; Kalra, Andrew ; Caturegli, Giorgio ; Zhang, Lucy Q. ; Bush, Errol ; Kim, Bo ; Keller, Steven P. ; Whitman, Glenn J. R. ; Cho, Sung-Min</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c475t-842b1fe15415eca8b07ec6bd04c3fcda505eff9206e2831f8487123119b8dd043</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Blood pressure</topic><topic>Brain death</topic><topic>Critical care</topic><topic>Critical Care Medicine</topic><topic>Edema</topic><topic>Electronic health records</topic><topic>Extracorporeal membrane oxygenation</topic><topic>Heart failure</topic><topic>Hypoxia</topic><topic>Intensive</topic><topic>Intensive care</topic><topic>Internal Medicine</topic><topic>Ischemia</topic><topic>Medical records</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mortality</topic><topic>Neurology</topic><topic>Neurosurgery</topic><topic>Original Work</topic><topic>Patients</topic><topic>Stroke</topic><topic>Tomography</topic><topic>Traumatic brain injury</topic><topic>Variables</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Shou, Benjamin L.</creatorcontrib><creatorcontrib>Wilcox, Christopher</creatorcontrib><creatorcontrib>Florissi, Isabella</creatorcontrib><creatorcontrib>Kalra, Andrew</creatorcontrib><creatorcontrib>Caturegli, Giorgio</creatorcontrib><creatorcontrib>Zhang, Lucy Q.</creatorcontrib><creatorcontrib>Bush, Errol</creatorcontrib><creatorcontrib>Kim, Bo</creatorcontrib><creatorcontrib>Keller, Steven P.</creatorcontrib><creatorcontrib>Whitman, Glenn J. R.</creatorcontrib><creatorcontrib>Cho, Sung-Min</creatorcontrib><creatorcontrib>HERALD Investigators</creatorcontrib><creatorcontrib>the HERALD Investigators</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Neurocritical care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Shou, Benjamin L.</au><au>Wilcox, Christopher</au><au>Florissi, Isabella</au><au>Kalra, Andrew</au><au>Caturegli, Giorgio</au><au>Zhang, Lucy Q.</au><au>Bush, Errol</au><au>Kim, Bo</au><au>Keller, Steven P.</au><au>Whitman, Glenn J. R.</au><au>Cho, Sung-Min</au><aucorp>HERALD Investigators</aucorp><aucorp>the HERALD Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Early Low Pulse Pressure in VA-ECMO Is Associated with Acute Brain Injury</atitle><jtitle>Neurocritical care</jtitle><stitle>Neurocrit Care</stitle><addtitle>Neurocrit Care</addtitle><date>2023-06-01</date><risdate>2023</risdate><volume>38</volume><issue>3</issue><spage>612</spage><epage>621</epage><pages>612-621</pages><issn>1541-6933</issn><eissn>1556-0961</eissn><abstract>Background
Pulse pressure is a dynamic marker of cardiovascular function and is often impaired in patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO). Pulsatile blood flow also serves as a regulator of vascular endothelium, and continuous-flow mechanical circulatory support can lead to endothelial dysfunction. We explored the impact of early low pulse pressure on occurrence of acute brain injury (ABI) in VA-ECMO.
Methods
We conducted a retrospective analysis of adults with VA-ECMO at a tertiary care center between July 2016 and January 2021. Patients underwent standardized multimodal neuromonitoring throughout ECMO support. ABI included intracranial hemorrhage, ischemic stroke, hypoxic ischemic brain injury, cerebral edema, seizure, and brain death. Blood pressures were recorded every 15 min. Low pulse pressure was defined as a median pulse pressure < 20 mm Hg in the first 12 h of ECMO. Multivariable logistic regression was performed to investigate the association between pulse pressure and ABI.
Results
We analyzed 5138 blood pressure measurements from 123 (median age 63; 63% male) VA-ECMO patients (54% peripheral; 46% central cannulation), of whom 41 (33%) experienced ABI. Individual ABIs were as follows: ischemic stroke (
n
= 18, 15%), hypoxic ischemic brain injury (
n
= 14, 11%), seizure (
n
= 8, 7%), intracranial hemorrhage (
n
= 7, 6%), cerebral edema (
n
= 7, 6%), and brain death (
n
= 2, 2%). Fifty-eight (47%) patients had low pulse pressure. In a multivariable model adjusting for preselected covariates, including cannulation strategy (central vs. peripheral), lactate on ECMO day 1, and left ventricle venting strategy, low pulse pressure was independently associated with ABI (adjusted odds ratio 2.57, 95% confidence interval 1.05–6.24). In a model with the same covariates, every 10-mm Hg decrease in pulse pressure was associated with 31% increased odds of ABI (95% confidence interval 1.01–1.68). In a sensitivity analysis model adjusting for systolic pressure, pulse pressure remained significantly associated with ABI.
Conclusions
Early low pulse pressure (< 20 mm Hg) was associated with ABI in VA-ECMO patients. Low pulse pressure may serve as a marker of ABI risk, which necessitates close neuromonitoring for early detection.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>36167950</pmid><doi>10.1007/s12028-022-01607-y</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0003-2825-3301</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1541-6933 |
| ispartof | Neurocritical care, 2023-06, Vol.38 (3), p.612-621 |
| issn | 1541-6933 1556-0961 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10040467 |
| source | SpringerLink Journals - AutoHoldings; ProQuest Central |
| subjects | Blood pressure Brain death Critical care Critical Care Medicine Edema Electronic health records Extracorporeal membrane oxygenation Heart failure Hypoxia Intensive Intensive care Internal Medicine Ischemia Medical records Medicine Medicine & Public Health Mortality Neurology Neurosurgery Original Work Patients Stroke Tomography Traumatic brain injury Variables |
| title | Early Low Pulse Pressure in VA-ECMO Is Associated with Acute Brain Injury |
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