PROJECT SUMMARY
Extracorporeal membrane oxygenation (ECMO) is a last resort procedure for patients with acute heart or lung
failure. The procedure carries signi¿cant risk of brain injury, yet no brain monitoring is performed, partly due to
signi¿cant risks of current neuroimaging technologies. Thus, the cause of these injuries, their relation with ECMO
settings, and how they can be prevented are unknown. A critical need exists for non-invasive techniques to mon-
itor brain physiology at the bedside for ECMO patients and for strategies to minimize brain injury. Our objective
is to develop a means to ¿nd predictors of neurologic functional outcome based on severity of injury assessment
in ECMO patients that can potentially lead to individualized optimization of extracorporeal support and timely
neuroprotective interventions. To this end, we have carefully selected multi-modal monitoring techniques that
can quantify cerebral autoregulation, neurovascular coupling, and neuronal health. To probe cerebral autoreg-
ulation based on microvascular blood ¿ow, diffuse correlation spectroscopy (DCS) will be used. Near-infrared
spectroscopy (NIRS) will provide blood oxygenation and volume information. Electroencephalogram (EEG) will
measure cortical electrical activity continuously, and evoked potentials (EPs) will measure the functionality of
subcortical nuclei in the brainstem and midbrain. We hypothesize that this combination will enable prediction of
functional outcome in patients undergoing ECMO. Furthermore, simultaneous measurements of hemodynamic
and electrophysiological parameters will provide a unique opportunity to investigate disruption of neurovascu-
lar coupling as an additional marker for brain injury. In Aim 1, we will construct several prediction models for
functional outcome based on multi-modal neuromonitoring parameters from ECMO patients and evaluate their
capabilities. In Aim 2, we will investigate whether our inter-hemispheric asymmetry measure of cerebral au-
toregulation, developed during preliminary studies, is a unique marker for ECMO by comparing patients with and
without ECMO treatment. In Aim 3, we will construct a new low-cost optical system and carefully validate against
established DCS and NIRS system. The new system will enable continuous monitoring for future multi-center
trials and multi-regional measurements.
Successful completion of these aims will result in great advances in ECMO and neurology research by provid-
ing a comprehensive innovative non-invasive longitudinal monitoring tool. In terms of ECMO, this work lays the
foundation for using this tool to optimize ECMO settings and reduce the occurrence of brain injuries in critically-ill
patients. Broadly, this multi-modal tool can be used to understand how the brain functions in diseased states in
order to discover treatments to prevent and treat neurologic disorders.