Technique Could Identify Patients at High Risk of Stroke or Brain Hemorrhage

Posted: Published on May 31st, 2013

This post was added by Dr Simmons

Newswise Measuring blood flow in the brain may be an easy, noninvasive way to predict stroke or hemorrhage in children receiving cardiac or respiratory support through a machine called ECMO, according to a new study by researchers at Nationwide Childrens Hospital. Early detection would allow physicians to alter treatment and take steps to prevent these complicationsthe leading cause of death for patients on ECMO.

Short for extracorporeal membrane oxygenation, ECMO is used when a patient is unable to sustain enough oxygen in the blood supply due to heart failure, septic shock, or other life-threatening condition, said Nicole OBrien, MD, a physician and scientist in critical care medicine at Nationwide Childrens and lead author of the study, which appears in a recent issue of the journal Pediatric Critical Care Medicine. The patient is connected to ECMO with tubes that carry the patients blood from a vein through the machine, where it is oxygenated and funneled back to the patient via an artery or vein that then distributes the oxygen-rich blood to vital organs and tissues.

The disease processes that lead someone to need ECMO are different, OBrien noted, but it is used only after traditional therapies, such as a ventilator, fail. One of the biggest risks of ECMO is bleeding in the brain. Only 36 percent of children who suffer this complication survive, many left with permanent neurologic injury.

Most of these patients are critically ill before they go on ECMO and often have low oxygen levels, low blood pressure and poor heart function, all of which can certainly lead to strokes, said OBrien, also an associate professor of clinical medicine at The Ohio State University College of Medicine. Still, some patients develop problems and others dont and we dont understand why.

To better understand the cause for these brain bleeds, OBrien launched a pilot study to monitor cerebral blood flow using a transcranial doplar ultrasound machine, a portable, noninvasive technology that uses sound waves to measure the amount and speed of blood flowing through the brain. All patients on ECMO experience a change in cranial blood flow, but OBrien wanted to see if those variations offered any hint as to why some patients had complications while others didnt.

She measured cranial blood flow in 18 ECMO patients, taking the first reading within the patients first 24 hours on the machine, then again each day they received the treatment and one more time after ECMO therapy ended.

When she compared these measurements to normal cerebral blood flow rates for children in the same age group, she found significant differences. Thirteen of the children in the study developed no neurologic complications while on ECMO. In these children, cerebral blood flow was 40 percent to 50 percent lower than normal. But in the five patients who had either a stroke or brain hemorrhage while on ECMO, cerebral blood flow was 100 percent higher than normal.

The age of the child, length of time on ECMO or the underlying illness didnt seem to matter. The only difference was that cerebral blood flow was dramatically increased in patients who ultimately had problems. While OBrien found that interesting, the most intriguing finding was that the increase in blood flow occurred as long as two to six days before the patient began bleeding in the brain.

That could give us a lot of lead time to prevent the brain bleeds or hemorrhages, said OBrien.

Physicians may decide to try to wean a patient off ECMO a little more quickly or change the dosage of anti-coagulant medication that all ECMO patients take.

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Technique Could Identify Patients at High Risk of Stroke or Brain Hemorrhage

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