Research in Focus shines a light on the innovative studies and discoveries taking shape across the UBC Department of Anesthesiology, Pharmacology & Therapeutics. Through each feature, we celebrate the minds driving meaningful change in research, education, and clinical practice across anesthesiology, pharmacology, and therapeutics.
When patients with acute respiratory distress syndrome (ARDS) become critically ill, VV-ECMO can be the lifesaving therapy that keeps them alive. However, starting this powerful form of life support may also place unexpected stress on the brain.
This prospective study by Dr. Donald Griesdale and his team investigates the mechanisms of brain injury in ARDS patients who require veno-venous extracorporeal membrane oxygenation (VV-ECMO). When VV-ECMO is initiated, it can cause a sudden and steep drop in arterial carbon dioxide (PaCO₂). This rapid change may trigger cerebral vasoconstriction, reducing blood flow to the brain and potentially leading to ischemic injury.
To capture what happens in the brain at the exact moment VV-ECMO begins, the study uses robotic transcranial Doppler ultrasound to continuously measure middle cerebral artery flow velocity, providing real-time data on cerebral blood flow changes. At the same time, blood samples are collected to assess biomarkers of neurologic injury (GFAP, NF-L, tau, UCH-L1), and neuroimaging and neurocognitive follow-up help map the long-term clinical impact.
The INFORM study aims to determine whether PaCO₂-related reductions in cerebral blood flow mediate neurologic injury, and ultimately to guide safer management strategies for VV-ECMO patients. By integrating critical care, neurophysiology, and translational neuroscience, this work seeks to improve neurologic outcomes for those facing severe respiratory failure.
“I love working with diverse researchers and teams to tackle a variety of problems. That’s particularly why I love clinical epidemiology.”
— Donald Griesdale, Associate Professor, UBC
Meet Donald Griesdale!
Site: Vancouver General Hospital (VGH)
Rank: Associate Professor
Dr. Griesdale is the associate director of the Centre for Clinical Epidemiology and Evaluation and an intensive care physician at VGH. He is also an assistant professor in the UBC Department of Anesthesiology, Pharmacology and Therapeutics with cross appointments in the UBC Department of Medicine, Division of Critical Care Medicine and Neurology.
Following his clinical training, Dr. Griesdale completed a Master of Public Health with a focus in Clinical Epidemiology. He has been fortunate to practice at the intersection of care delivery and research.
Responses have been edited for flow, clarity, and style.
What drew you to this particular research question or problem?
I’ve always enjoyed trying to understand the link between physiology and outcomes. The data underpinning the association between PaCO₂ and neurologic injury is tenuous at best. Thus, actually examining cerebral flow velocity as a surrogate for blood flow during cannulation for ECMO was an opportunity we couldn’t pass up.
What surprised you the most in this study?
The most surprising aspect of this project was the willingness of the entire team to perform TCD while patients were being cannulated for ECMO. I’m grateful to my colleagues for allowing me to explore this area of inquiry and for being so supportive throughout the journey.
Outside of work, what do you enjoy the most?
I have three boys aged 20, 16, and 14. Along with my wife Peggy, we love to do outdoor activities like camping and hiking. I also love landscape, street, and wildlife photography.
What’s been the most rewarding moment in your research journey so far?
Honestly, I love working with diverse researchers and teams to tackle a wide variety of problems. That’s particularly why I enjoy clinical epidemiology — there are so many different approaches you can use. I also enjoy learning about different quantitative and qualitative methods.