Cerebral Blood Flow Hemispheric Asymmetry in Comatose Adults Receiving Extracorporeal Membrane Oxygenation

Thomas W Johnson; Irfaan A Dar; Kelly L Donohue; Yama Y Xu; Esmeralda Santiago; Olga Selioutski; Mark A Marinescu; Ross K Maddox; Tong Tong Wu; Giovanni Schifitto; Igor Gosev; Regine Choe; Imad R Khan

doi:10.3389/fnins.2022.858404

Cerebral Blood Flow Hemispheric Asymmetry in Comatose Adults Receiving Extracorporeal Membrane Oxygenation

Front Neurosci. 2022 Apr 11:16:858404. doi: 10.3389/fnins.2022.858404. eCollection 2022.

Authors

Thomas W Johnson¹, Irfaan A Dar², Kelly L Donohue³, Yama Y Xu⁴, Esmeralda Santiago⁴, Olga Selioutski¹, Mark A Marinescu⁵, Ross K Maddox^{2

6}, Tong Tong Wu⁷, Giovanni Schifitto¹, Igor Gosev⁸, Regine Choe^{2

9}, Imad R Khan¹

Affiliations

¹ Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States.
² Department of Biomedical Engineering, University of Rochester, Rochester, NY, United States.
³ Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
⁴ School of Arts and Sciences, University of Rochester, Rochester, NY, United States.
⁵ Department of Medicine, University of Rochester Medical Center, Rochester, NY, United States.
⁶ Department of Neuroscience, University of Rochester Medical Center, Rochester, NY, United States.
⁷ Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, United States.
⁸ Division of Cardiac Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY, United States.
⁹ Department of Electrical and Computer Engineering, University of Rochester, Rochester, NY, United States.

Abstract

Peripheral veno-arterial extracorporeal membrane oxygenation (ECMO) artificially oxygenates and circulates blood retrograde from the femoral artery, potentially exposing the brain to asymmetric perfusion. Though ECMO patients frequently experience brain injury, neurologic exams and imaging are difficult to obtain. Diffuse correlation spectroscopy (DCS) non-invasively measures relative cerebral blood flow (rBF) at the bedside using an optical probe on each side of the forehead. In this study we observed interhemispheric rBF differences in response to mean arterial pressure (MAP) changes in adult ECMO recipients. We recruited 13 subjects aged 21-78 years (7 with cardiac arrest, 4 with acute heart failure, and 2 with acute respiratory distress syndrome). They were dichotomized via Glasgow Coma Scale Motor score (GCS-M) into comatose (GCS-M ≤ 4; n = 4) and non-comatose (GCS-M > 4; n = 9) groups. Comatose patients had greater interhemispheric rBF asymmetry (ASYM_rBF) vs. non-comatose patients over a range of MAP values (29 vs. 11%, p = 0.009). ASYM_rBF in comatose patients resolved near a MAP range of 70-80 mmHg, while rBF remained symmetric through a wider MAP range in non-comatose patients. Correlations between post-oxygenator pCO₂ or pH vs. ASYM_rBF were significantly different between comatose and non-comatose groups. Our findings indicate that comatose patients are more likely to have asymmetric cerebral perfusion.

Keywords: cerebral blood flow; cerebrovascular autoregulation; coma; diffuse correlation spectroscopy; extracorporeal membrane oxygenation.