Keeping an Eye on the Brain: Neuromonitoring With Automated Pupillometry During Pediatric Extracorporeal Membrane Oxygenation

Abstract

Extracorporeal membrane oxygenation is an advanced form of respiratory and cardiorespiratory life support. While it can be an extremely effective form of life support, it comes with significant risks including the risk of severe neurologic injury. Even if a patient survives their initial illness, neurologic injuries sustained while receiving extracorporeal membrane oxygenation can lead to lifelong impairment and disability or even death. Accurate neurologic monitoring for the duration of therapy is critical to ensure timely recognition of neurologic changes and subsequent prompt intervention; however, current modalities for neurologic monitoring are severely limited in the pediatric patient population. Automated pupillometry is a relatively new, noninvasive, handheld device for quantitative pupil assessment that does not rely on the interpretation of the individual assessor. This project was designed to assess whether automated pupillometry provides an earlier indication of neurologic injury than clinician suspicion of injury among children receiving extracorporeal membrane oxygenation. Using the Synergy Model as a framework, this paper describes how the use of this bedside neuromonitoring tool may improve nursing advocacy for critically ill patients by allowing for earlier detection of signs of neurologic injury and subsequent timely intervention.