For information only.
http://www.newswise.com/articles/technique-could-identify-patients-at-high-risk-of-stroke-or-brain-hemorrhage
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 Children’s Hospital.
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, which appears in a recent issue of the journal Pediatric Critical Care Medicine.
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,” said O’Brien, also an associate professor of clinical
medicine at The Ohio State University College of Medicine. “Still, some
patients develop problems and others don’t and we don’t understand why.”
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. While O’Brien 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 O’Brien.
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.
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.
“We still need to understand why these kids
bleed and why they stroke,” said O’Brien. “This little piece of
information is the very tip of the iceberg in terms of why that
happens.”
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My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.
Thursday, May 30, 2013
Technique Could Identify Patients at High Risk of Stroke or Brain Hemorrhage
Labels:
blood flow,
ECMO,
hemorrhage
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