Association Between Disrupted Cerebral Autoregulation and Radiographic Neurologic Injury for Children on Extracorporeal Membrane Oxygenation: A Prospective Pilot Study.

Validation of a real-time monitoring device to evaluate the risk or occurrence of neurologic injury while on extracorporeal membrane oxygenation (ECMO) may aid clinicians in prevention and treatment. Therefore, we performed a pilot prospective cohort study of children under 18 years old on ECMO to analyze the association between cerebral blood pressure autoregulation as measured by diffuse correlation spectroscopy (DCS) and radiographic neurologic injury. DCS measurements of regional cerebral blood flow were collected on enrolled patients and correlated with mean arterial blood pressure to determine the cerebral autoregulation metric termed DCSx. The primary outcome of interest was radiographic neurologic injury on eligible computed tomography (CT) or magnetic resonance imaging (MRI) scored by a blinded pediatric neuroradiologist utilizing a previously validated scale. Higher DCSx scores, which indicate disruption of cerebral autoregulation, were associated with higher radiographic neurologic injury score (slope, 11.0; 95% confidence interval [CI], 0.29-22). Patients with clinically significant neurologic injury scores of 10 or more had higher median DCSx measures than patients with lower neurologic injury scores (0.48 vs . 0.13; p = 0.01). Our study indicates that obtaining noninvasive DCS measures for children on ECMO is feasible and disruption of cerebral autoregulation determined from DCS is associated with higher radiographic neurologic injury score.

Perioperative Spinal Cord Ischemia After Cardiac Surgery Not Involving the Aorta: A Review of the Literature.

Spinal cord ischemia (SCI) associated with aortic surgery is well-described; however, SCI after cardiac surgery not involving the aorta is an unusual and underappreciated phenomenon. The authors reviewed the literature and found 54 case reports of perioperative spinal cord ischemia in nonaortic surgery. The severity of its implications is evidenced by the fact that 14 patients died, 22 had no recovery, and seven had only partial recovery. Various types of cardiac surgery have reported this complication including coronary artery bypass grafting (CABG), off-pump CABG, valve surgeries, combination valve and CABG surgeries, and transcatheter aortic valve procedures. Patient comorbidities, such as high blood pressure, hypercholesterolemia, diabetes, and peripheral vascular disease, also may play a role in the development of this adverse outcome. The authors review the literature to define further possible mechanisms, surgical techniques, and patient factors that could contribute to the risk of perioperative SCI after cardiac surgery.