Our Summary

This research paper discusses the importance of monitoring the brain function and health in patients who are undergoing a treatment known as extracorporeal membrane oxygenation (ECMO). ECMO is a treatment that uses a machine to take over the work of the lungs (and sometimes the heart) when the patient’s body can’t do so on its own. It has been found that patients undergoing ECMO are at risk of various brain complications, some of which can have long-term effects on their cognitive function. These complications can range from well-known issues like bleeding, strokes, and seizures, to less defined but still significant injuries.

Currently, there are no widely accepted protocols for how to manage and monitor these risks and complications. The techniques that are currently used to monitor brain health during ECMO treatment are somewhat limited and often only identify damage after it has occurred and become irreversible.

The authors suggest that continuous monitoring of brain blood flow, regular assessment of certain markers in the blood that can indicate brain injury, timely brain imaging, and post-treatment counselling for cognitive dysfunction could help improve patient outcomes. Especially in children, these strategies could help identify and address brain health issues not only during their hospital stay, but also in the long-term. However, more research is needed to confirm whether these strategies are cost-effective.

FAQs

  1. What is extracorporeal membrane oxygenation (ECMO) and why is it important to monitor the brain function of patients undergoing this treatment?
  2. What are the potential brain complications for patients undergoing ECMO treatment and how can they be managed or monitored?
  3. What strategies do the authors suggest to improve patient outcomes during and after ECMO treatment?

Doctor’s Tip

A helpful tip a doctor might tell a patient about brain surgery is to follow all post-operative instructions carefully, including taking prescribed medications, attending follow-up appointments, and avoiding activities that could put strain on the surgical site. It is important to give the brain enough time to heal properly in order to achieve the best possible outcome. Additionally, maintaining a healthy lifestyle with regular exercise, a balanced diet, and adequate sleep can help support the healing process and overall brain health.

Suitable For

Patients who are typically recommended for brain surgery include those with tumors, aneurysms, arteriovenous malformations, epilepsy that cannot be controlled with medication, traumatic brain injuries, hydrocephalus, and certain neurological conditions such as Parkinson’s disease and essential tremor. Additionally, patients with conditions such as brain abscesses, brain cysts, and certain types of infections may also require brain surgery.

It is important for patients to undergo a thorough evaluation by a neurosurgeon to determine if brain surgery is the best course of treatment for their specific condition. Factors such as the location and size of the lesion, the patient’s overall health and medical history, and the risks and benefits of surgery must be carefully considered before recommending surgery.

Overall, brain surgery is typically recommended for patients with conditions that cannot be effectively treated with medication or other non-invasive treatments, and where surgery offers the best chance for improvement or cure. It is important for patients to discuss their options with their healthcare provider and weigh the potential risks and benefits before making a decision about undergoing brain surgery.

Timeline

Before brain surgery:

  1. Patient undergoes various diagnostic tests such as MRI or CT scans to determine the need for surgery.
  2. Patient consults with neurosurgeon to discuss the procedure, risks, and potential outcomes.
  3. Patient may undergo pre-operative tests and evaluations to ensure they are healthy enough for surgery.
  4. Patient may be instructed to follow certain pre-operative instructions, such as fasting or stopping certain medications.
  5. Patient undergoes brain surgery, which can vary depending on the specific condition being treated.

After brain surgery:

  1. Patient is monitored closely in the intensive care unit (ICU) for any immediate complications.
  2. Patient may be transferred to a regular hospital room once stable.
  3. Patient may experience side effects such as headaches, nausea, or cognitive changes in the immediate post-operative period.
  4. Patient may undergo physical therapy, occupational therapy, or speech therapy to aid in recovery.
  5. Patient may be prescribed medications to manage pain or prevent infection.
  6. Patient may have follow-up appointments with their neurosurgeon to monitor their recovery and address any ongoing issues.
  7. Patient may experience improvements in their condition over time, but may also have long-term effects on cognitive function or physical abilities.

What to Ask Your Doctor

Some questions a patient should ask their doctor about brain surgery include:

  1. What specific brain surgery procedure is being recommended for me?
  2. What are the potential risks and complications associated with this brain surgery?
  3. How long will the recovery process be and what can I expect during this time?
  4. Will I need any special rehabilitation or therapy after the surgery?
  5. How will my cognitive function be monitored during and after the surgery?
  6. Are there any specific markers or tests that will be used to assess my brain health?
  7. What steps will be taken to prevent or minimize any potential brain complications during the surgery?
  8. How will my brain health be monitored in the long-term following the surgery?
  9. Are there any specific signs or symptoms I should watch out for that may indicate a problem with my brain health post-surgery?
  10. Are there any lifestyle changes or precautions I should take to protect my brain health following the surgery?

Reference

Authors: Lorusso R, Taccone FS, Belliato M, Delnoij T, Zanatta P, Cvetkovic M, Davidson M, Belohlavek J, Matta N, Davis C, Ijsselstijn H, Mueller T, Muellenbach R, Donker D, David P, Di Nardo M, Vlasselaers D, Dos Reis Miranda D, Hoskote A; Euro-ELSO Working Group on Neurologic Monitoring and Outcome. Journal: Minerva Anestesiol. 2017 Oct;83(10):1061-1074. doi: 10.23736/S0375-9393.17.11911-5. Epub 2017 Jun 22. PMID: 28643997