Association of Cerebral Oximetry with Outcomes after Extracorporeal Membrane Oxygenation

Abstract

Background: Extracorporeal membrane oxygenation (ECMO) is associated with neurologic morbidity and mortality. We investigated whether cerebral regional oxygen saturation (rSO 2 ) is associated with neurologic outcomes and survival in children on ECMO. Methods:This was a retrospective observational study of children ages 1 day to 20 years who underwent ECMO with routine cerebral rSO 2 monitoring in the pediatric intensive care unit at a single academic center between February 2008 and September 2014. We collected all serial rSO 2 values recorded in the electronic medical record during the ECMO course. Favorable outcome was defined as survival with Pediatric Cerebral Performance Category (PCPC) ≤2 at hospital discharge or no decline from baseline PCPC.Results: We reviewed data from 153 patients who underwent 156 ECMO runs. The median age was 12.5 days (interquartile range [IQR], 2 days -15 months). Ninety-nine (64%) patients survived to hospital discharge, and 82/99 (83%) survivors had favorable neurologic outcome by discharge PCPC. Neuroimaging studies were obtained in 135 (87%) patients, 59 (44%) of which showed abnormal findings. Ninety-two (59%) patients had any rSO 2 ≤50%, 60 (38%) had any rSO 2 decline >20% from baseline, and 26 (17%) had any rSO 2 decline >20% from the reading 1 h prior. Any rSO 2 ≤50% and any rSO 2 decline >20% from baseline were each associated with unfavorable outcome at hospital discharge (multivariable-adjusted odds ratio [OR], 2.82 [95% CI, 1.10-7.25] and 4.52 [95% CI, 1.76-11.58], respectively). rSO 2 decline >20% from the reading 1 h prior was not significantly associated with the outcomes. Conclusion:Among children in one institution who underwent routine clinical rSO 2 monitoring during ECMO, rSO 2 decline was associated with unfavorable short-term neurologic outcome and death after adjusting for potential confounders. The effectiveness of initiating early preventative measures in these high-risk patients needs further study.

ECMO in neonates: The association between cerebral hemodynamics with neurological function

“…The right cerebral blood flow decreased during ECMO and was more susceptible to the interference of autoregulatory function, which seemed to explain the susceptibility to ANI in the right cerebral hemisphere. Additional studies showed that decreased cerebral oxygenation was associated with adverse short-term neurological outcomes and death (50)(51)(52)(53). In addition, a high rScO2 (>80%) was a protective factor that might predict a lower in-hospital mortality (54).…”

Application of Near-Infrared Spectroscopy to Monitor Perfusion During Extracorporeal Membrane Oxygenation After Pediatric Heart Surgery

“…The area under the ROC curve was 0.769 (p = 0.03) for CrSO 2 at 36 h and 0.758 (p = 0.038) at 48 h. The optimal cutoff values for CrSO 2 for the prediction of mortality after weaning off ECMO was 57% at 36 h (sensitivity: 61.5%, specificity: 80%) and 56% at 48 h (sensitivity: 76.9%, specificity: 70%). Similarly, Tsou et al (11) showed that any regional oxygen saturation index (rSO 2 ) levels ≤ 50% were associated with unfavorable outcomes at hospital discharge [multivariable-adjusted odds ratio (OR), 2.82 (95% CI: 1.10-7.25)]. Kim et al also showed the optimal cutoff values for right-sided and left-sided CrSO 2 for predicting mortality were 58% (sensitivity: 78.7%, specificity: 83.3%) and 57% (sensitivity: 80.0%, specificity: 70.8%), respectively (9).…”

Cerebral Tissue Regional Oxygen Saturation as a Valuable Monitoring Parameter in Pediatric Patients Undergoing Extracorporeal Membrane Oxygenation

“…At the same time, we did not explore the correlation between CrSO 2 and neurologic complications. Studies found that lower CrSO 2 and more frequently occurrence of cerebral desaturation in patients with ECMO were more likely related to brain injury (19,27,28). However, different studies had different definitions of cerebral desaturation and brain injury.…”