ECMO-/ECLS

electrodes to be placed on the scalp for at least 12 continuous hours, one may
detect subclinical seizures. In the absence of physical manifestations of
epileptiform activity, the clinician may use the continuous EEG to evaluate the
effectiveness of sequential therapies. Consideration should be given to
prolonged EEG in patients at risk (status epilepticus, history of refractory
seizures, head injury, cerebral ischemia). Skin breakdown with prolonged (>1- 2
days) electrode placement has been reported.
Bispectral index (BIS, Covidien) monitoring has been developed to
evaluate the state of wakefulness of patients under sedation and anesthesia.
The device utilizes a single sensor placed on the patient’s forehead and employs
complex algorithms to analyze the brain electrical activity to infer the level of
consciousness (0=unconscious, 100=fully awake). In adults, values less than 20
are considered excessively ‘deep’ anesthesia while values greater than 70 may
suggest inadequate anesthesia for noxious procedures. Routine use in adults
has been shown to decrease intraoperative awareness, but this has not been
validated in children. Nevertheless, there is growing interest in using this
technology in ICU settings where patients may undergo prolonged sedation.
Special Considerations in infants versus older children
Many of the monitoring devices discussed above have either not been
used in infants or have not been adequately validated to interpret absolute
values. While reasonable norms exist for physiologic measures such as heart
rate, blood pressure, temperature, arterial blood gas values, urine output, and
others, equivalent reference points for ICP, CPP, local brain P0 2 and metabolic