Scientists from the United States invented a new, simple and non-invasive way to assess the risk of hemorrhagic stroke in children who are on the extracorporeal membrane oxygenation (ECMO).

This method consists in measuring the cerebral blood flow. The results of the scientific work were published in the American journal Pediatric Critical Care Medicine.

Stroke, as is known, is the leading cause of death of cardiac patients, who are placed on ECMO. When the patient does not maintain a sufficient level of oxygen in the blood as a result of respiratory or heart failure, he needs ECMO to, for example, hold out until he receives a donor heart. ECMO is used only when another therapy does not work.

When ECMO patient is connected to a membrane oxygenator, which outside the body enriches the blood with oxygen and simultaneously removes carbon dioxide from it. This method is used for sepsis, respiratory and heart failure.

Despite unique possibilities, this method is associated with a high risk of cerebral hemorrhage. Only 36% of patients on ECMO can survive after such a serious complication.

Dr. Nicole O'Brien, Principal Investigator, Associate Professor of Clinical Medicine at the College of Medicine at Ohio State University, says: "Most patients are connected to the ECMO device already in very serious condition, they usually have low blood oxygenation, low blood pressure and poor heart function. Many factors in patients on ECMO contribute to a stroke. Some patients have such problems, others do not, and it is not completely clear why ».

Scientists from the National Children's Hospital (NCH) conducted a study in which they measured cerebral blood flow using transcranial dopplerography (TCDG) - a kind of ultrasound.

Changes in blood flow in the brain occur in all patients on ECMO. But scientists wanted to find out why some patients have complications, while others do not have. A total of 18 patients participated in the study at ECMO. Assessment of cerebral blood flow was carried out every day, starting from the first day of the procedure.

There were significant differences in the rate of cerebral blood flow in patients on ECMO compared with healthy children of the same age. In 13 of 18 patients, there were no neurological complications during ECMO. In these 13 children, cerebral blood flow was 40-50% below normal.

The other 5 patients had a stroke, while all of them had cerebral blood flow higher than normal. Factors such as age and the initial disease did not affect the risk.

Scientists concluded that before cerebral hemorrhage in patients on ECMO cerebral blood flow increased, which is registered with the help of TCDG. This gives doctors enough time to prevent a stroke. Dr. O'Brien says: "We still need to understand why this happens only in some children. Our study revealed only the tip of the iceberg ".

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