SNF Brain Stroke Samachar-440

[SN Foundation]

Cerebral blood flow could predict patients at high risk of stroke or
brain hemorrhage
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Courtesy: ANI
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Washington: Researchers at Nationwide Children`s Hospital have
suggested that 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.

Early detection would allow physicians to alter treatment and take
steps to prevent these complications-the 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 O`Brien, MD, a physician and scientist in critical care
medicine at Nationwide Children`s and lead author of the study.

The patient is connected to ECMO with tubes that carry the patient`s
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,
O`Brien 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. Still, some
patients develop problems and others don`t and we don`t understand
why," said O`Brien, also an associate professor of clinical medicine
at The Ohio State University College of Medicine.

To better understand the cause for these brain bleeds, O`Brien
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
O`Brien wanted to see if those variations offered any hint as to why
some patients had complications while others didn`t.

She measured cranial blood flow in 18 ECMO patients, taking the first
reading within the patient`s 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
didn`t seem to matter. The only difference was that cerebral blood
flow was dramatically increased in patients who ultimately had
problems.

Although O`Brien is excited about the results, she is careful to note
that the findings are preliminary. She is planning a multi-center
trial to see if the outcome will be the same in a larger study
population.The study appeared in a recent issue of the journal
Pediatric Critical Care Medicine.
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