Impaired Cerebral Autoregulation, Neurologic Injury, and Modifiable Clinical Factors in Pediatric ECMO: An analysis of prospectively collected, multicenter, high-frequency physiologic data

Ethan Sanford, MD is a pediatric critical care physician and anesthesiologist at UT Southwestern Medical Center in Dallas, Texas. His goal is to become an expert in cerebral autoregulation monitoring and management during pediatric critical illness. He aims become a funding, independent researcher of clinical interventions that improve neurologic outcomes in pediatric critical care. Dr. Sanford plans to use prospectively collected, multicenter data to study cerebral autoregulation determined from non-invasive monitors for a large population of children who require extracorporeal membrane oxygenation (ECMO). ECMO rescues children with cardiopulmonary failure, but is associated with high risk of neurologic injury. Current neuromonitoring techniques are either time-sparse, require expert interpretation, are not possible on ECMO, or only diagnose injuries after they occur. Dr. Sanford’s innovative approach utilizes monitoring devices commonly used in ECMO patients to create new information regarding cerebrovascular health. Specifically, Dr. Sanford will use mathematical models to determine the time-duration of impaired cerebral autoregulation from high-frequency, time-matched cerebral oximetry and mean arterial blood pressure data. Pediatric ECMO patients are at risk for impaired cerebral autoregulation. Knowledge gaps exist regarding the burden of impaired cerebral autoregulation during ECMO, associated outcomes, and modifiable clinical factors that impact cerebral autoregulation. Dr. Sanford’s specific aims are to determine 1) whether impaired cerebral autoregulation is associated with severe neurologic injury for pediatric ECMO patients and 2) Determine whether changes in carbon dioxide during ECMO are associated with changes in cerebral autoregulation and neurologic injury. The proposed study will deliver novel insight regarding neurologic outcomes related to impaired cerebral autoregulation. Perhaps more importantly, Dr. Sanford will assess relationships between potentially modifiable clinical factors (carbon dioxide) and cerebral autoregulation; a foundation for future interventional trials to improve cerebral autoregulation and improve neurologic outcomes of ECMO care. Dr. Sanford works with a multidisciplinary team of mentors with expertise in neurologic injury during ECMO (Lakshmi Raman, MD), neuro-optical techniques (David Busch, PhD), mathematical modelling (Hanli Liu, PhD), and cerebral autoregulation physiology (Rong Zhang, PhD). This group has a track record of productive collaboration. The UT Southwestern Medical Center is a high-volume ECMO center with strong clinical research programs which will be leveraged for Dr. Sanford’s research and career development. Dr. Sanford will address key training goals to establish an independent research program including 1) gaining expertise in cerebral autoregulation physiology, non-invasive monitoring of cerebral autoregulation, and data processing and 2) developing skills in interventional study design and multicenter collaborative studies. Completion of the proposed study and training goals will lead to Dr. Sanford’s independent research program in cerebrovascular health. Project Number: 1K23NS142708-01A1 | Fiscal Year: 2026 | NIH Institute/Center: National Institute of Neurological Disorders and Stroke (NINDS) | Principal Investigator: Ethan Sanford | Institution: UT SOUTHWESTERN MEDICAL CENTER, DALLAS, TX | Award Amount: $219,483 | Activity Code: K23 | Study Section: Special Emphasis Panel[ZRG1 CN-V (91)] View on NIH RePORTER: https://reporter.nih.gov/project-details/11371278