Extracorporeal Membrane Oxygenation Evaluated by Transcranial Doppler.

Study Overview
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Brief Summary
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To determine how venoarterial extracorporeal membrane oxygenation (ECMO) affects cerebral blood flow velocity (CBFV) measured by transcranial doppler (TCD), to determine whether specific changes in cerebral blood flow velocity may be associated with neurologic injury and to determine modifications of CBFV after withdrawal of ECMO.

Detailed Description
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Venoarterial Extracorporeal membrane oxygenation (ECMO) is used in adult with refractory cardiac failure as a life-saving measure. Adults treated with ECMO survived to hospital discharge in 21,8% to 65,4% of cases. Neurologic complications such as intracranial hemorrhage, anoxia and ischemia are major causes of death and long-term disability in ECMO patients (7% to 14%). Current neurological monitoring techniques are insufficient to predict which critically ill patient receiving ECMO therapy will suffer from neurologic injury. Even after a clinical suspicion of neurologic injury, diagnosis can be difficult. TCD is commonly used to monitor the CBFV of traumatic brain injury. There are no reports that evaluate CBFV of patients requiring ECMO therapy. Patient will have to do both echocardiography and TCD to evaluate cardiac output and CBFV. We will repeat these dopplers every 24 hours until ECMO withdrawal and one day after explantation.

Official Title
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Extracorporeal Membrane Oxygenation and Cerebral Blood Flow Velocity Evaluated by Transcranial Doppler

Conditions
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Extracorporeal Membrane Oxygenation Complication

Intervention / Treatment
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* Other: Examination : a TCD and Trans-Thoracic Echocardiography


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: adult patient who receiving ECMO therapy Exclusion Criteria: cervico-encephalic vasculopathy lacked an acoustic window allowing for adequate TCD examination stroke in medical past.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Intervention Model: Single Group Assignment
Interventional Model Description: Patient treated with Venoarterial Extracorporeal membrane oxygenation (ECMO) Realization of transcranial doppler (TCD) of the right and left middle cerebral artery in the first 48 hours of the setting up of the ECMO with joint realization of an Trans-thoracic echocardiography (TTE) then every 24 hours until the end of the using of the ECMO and the realization of TCD and TTE during the 24 hours after removal of the ECMO.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Patient treated with ECMO<br>Patient treated with ECMO will have Examination : a TCD and Trans-Thoracic Echocardiography (TTE) | Other: Examination : a TCD and Trans-Thoracic Echocardiography<br>* Examination that involves the completion of a TCD and an TTE (Trans-Thoracic Echocardiography) : To reports clinical parameters at the time of the examination : ECG data: sinus rhythm, atrial or ventricular arrhythmia, state of consciousness, heart rate, O2 saturation To review of pharmacological parameters at the time of the examination : presence of sedation; presence, type and dose of catecholamines. To collect biological data from the day of the examination : Partial Pressure of O2, PaCO2 (partial pressure) and hematocrit To collect possible additional examinations : brain scan, EEG. These are non-invasive exams that do not require patient displacement. Only the samples taken by the medical team as part of the treatment will be analyzed.<br>* Other names: Examination that involves a TCD and an TTE;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cerebral blood flow velocities evolution | Cerebral blood flow velocities evolution over the time | 24 hours | 
| The correlation of Cerebral blood flow velocities with the variation of the cardiac output and ECMO flow. | The correlation with the variation of the cardiac output and ECMO flow. | 24 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Relation between acute neurologic injury and variation of CBFV | Relation between acute neurologic injury and variation of CBFV detected by TCD. | 24 hours | 
| Modification of the CBFV detected by TCD after the withdrawal of the ECMO. | Modification of the cerebral blood flow velocity (CBFV) detected by TCD after the withdrawal of the ECMO. | 24 hours | 
| Relation between the CBFV, the NIRS, the cardiac flow and the ECMO flow. | Relation between the CBFV (cerebral blood flow velocity), the Near Infrared Spectroscopy (NIRS), the cardiac flow and the ECMO flow. | 24 hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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neurologic complication, transcranial Doppler ultrasound