ArticleFrontiers in cardiovascular medicine2026
A case report of cardiogenic shock with transcranial color-coded ultrasound monitoring under ECMO.
Article in Frontiers in cardiovascular medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Cardiogenic shock (CS) during venoarterial extracorporeal membrane oxygenation (VA-ECMO) support carries high mortality, often due to neurological injury. Precise matching of ECMO flow to cerebral perfusion is critical. Transcranial color-coded sonography (TCCS) offers real-time, non-invasive hemodynamic assessment to guide flow titration, though its clinical integration remains limited. Case presentation: This study reports a 58-year-old male firefighter who suffered out-of-hospital cardiac arrest due to acute myocardial infarction, resulting in CS, right frontal lobe hemorrhage, and hypoxic-ischemic encephalopathy. VA-ECMO was initiated on-site and maintained post-resuscitation alongside intra-aortic balloon pump (IABP) and continuous renal replacement therapy (CRRT). TCCS was used throughout hospitalization to monitor middle cerebral artery flow parameters [including pulsatility index (PI), resistivity index (RI), and non-invasive intracranial pressure (nICP)]. These flow indexes were used to guide dynamic ECMO flow adjustments (gradually decreased from 3.25 L/min to 2.12 L/min) to preserve cerebral perfusion within target ranges. At the three-month follow-up, his neurological function recovered, and he was living independently. Six-month follow-up revealed progressive resolution of the intracranial hemorrhage. Conclusion: This case demonstrates the feasibility of TCCS-guided neuromonitoring during ECMO support for CS. TCCS provided real-time cerebral hemodynamic data that informed bedside ECMO flow titration. Whether this approach mitigates secondary brain injury or improves neurological outcomes requires further validation.
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