ANTICOAGULATION AND NEUROMONITORING DURING EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)
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Extracorporeal membrane oxygenation (ECMO) is a life-saving technique of cardiopulmonary bypass employed in intensive care units since 1976.1 ECMO is used in >1,000 children each year for cardiopulmonary failure refractory to maximal medical management, when chances of mortality exceed 80%.2 However, ECMO patients are at high risk for neurologic injury due to cannulation of large neck vessels, systemic anticoagulation and altered cerebrovascular dynamics. As many as 28%-52% of patients have abnormal neuroimaging findings during ECMO,3-8 and poor neurologic outcomes have been reported in 10% to 60% of survivors.7, 9, 10 The work presented in this thesis is organized around monitoring for coagulopathy, a risk factor for neurologic injury during ECMO, and monitoring for neurologic injury during ECMO by using plasma brain injury biomarkers. The overarching goal of our research program is to improve clinical care of ECMO patients to mitigate risk factors leading to acute neurologic injury and subsequent poor neurodevelopmental outcomes of these critically ill children.