[Best evidence summary for the prevention and management of brain injury in patients with extracorporeal membrane oxygenation].

Abstract

Objective: To search, evaluate and summarize evidence for the prevention and management of brain injury in patients supported by extracorporeal membrane oxygenation (ECMO), and to provide evidence-based basis for the prevention and management of brain injury during ECMO support.

Methods: A systematic search was conducted in the following databases and resources for clinical decision support tools, guidelines, expert consensus, systematic reviews and high-quality original studies related to the prevention and management of brain injury in ECMO-supported patients: UpToDate, BMJ Best Practice, JBI evidence-based Health Care Center Database, the Cochrane Library, the National Institute for Health and Care Excellence (NICE), the Scottish Intercollegiate Guidelines Network (SIGN), the National Guideline Clearinghouse (NGC), Yimaitong, Extracorporeal Life Support Organization (ELSO), the American College of Cardiology (ACC), PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), China Biomedical Literature Service System (SinoMed), CNKI, Wanfang Database, VIP Database and other Chinese and English databases, professional team websites, and guideline websites. The search time range is from the establishment of the database to May 2025. Two researchers with systematic training backgrounds in evidence-based nursing methods independently evaluated the quality of the literature, and extracted and summarized the evidence from the literature that met the quality standards.

Results: A total of 18 publications were ultimately included, comprising 4 guidelines, 3 expert consensuses, 4 systematic reviews, and 7 original studies [including 1 randomized controlled trial (RCT), 4 cohort studies, and 2 case studies]. Through synthesis, 31 pieces of best evidence for the prevention and management of brain injury in ECMO-supported patients were formulated, covering five major themes: risk factors of brain injury, protective factors of brain injury, assessment and monitoring during treatment, prevention of brain injury, and treatment measures for brain injury.

Conclusions: This evidence provides the best evidence-based basis for the prevention and management of brain injury during ECMO treatment. It is recommended to selectively apply the best evidence in combination with the actual clinical environment of medical institutions and individual differences of patients, and to prevent and manage brain injury in ECMO-supported patients in a personalized and reasonable manner.