Cerebral and Peripheral Tissue Oxygenation in Children Supported on ECMO for Cardio-Respiratory Failure

Abstract

Extracorporeal membrane oxygenation (ECMO) is a rescue therapy for patients with cardio-respiratory failure. Establishing, maintaining and weaning from ECMO may increase the risk for intracranial injury. We used a dual channel near infrared system to monitor cerebral and peripheral tissue oxygenation in 3 venoarterial (VA) and 1 venovenous (VV) ECMO patients undergoing manipulations in the ECMO circuit flows. Spectral analysis was performed on the oxyhaemoglobin data collected from these patients with the aim of comparing oscillations at range of frequencies appearing in the two measurement sites.

Multichannel near infrared spectroscopy indicates regional variations in cerebral autoregulation in infants supported on extracorporeal membrane oxygenation

“…In addition, previous work on spectral analysis using Fourier transforms on patients supported on ECMO showed that oscillations in HbO 2 are stronger than in other NIRS parameters. 9 The presence of slow spontaneous oscillations may be more significant in the oxyhaemoglobin signal measured by NIRS than in the deoxyhaemoglobin or total haemoglobin signal. 38,39 However, Payne and colleagues used both HbO 2 and HbD when calculating the synchronization index, an alternative method based on CWT, and have shown differences between the results of the two parameters.…”

“…In a previous study, we have used a dual NIRS system and showed the presence of oscillations related to vasomotion, mechanical oscillations from the ECMO pump, respiration rate, and heart rate. 9 Slow oscillations in the vasomotion range were observed in the peripheral circulation and not in the brain of a number of ECMO patients while in other cases the slow oscillations appeared in both peripheral and cerebral circulations. Preliminary results using a multichannel NIRS system indicate regional variation in cerebral oxygenation responses during ECMO flow changes.…”

“…Typical frequency methods for investigating the regulation of cerebral haemodynamics include power spectral analysis under various physiological or pathological conditions. 8,9 However, large inter-subject variability is often found in these absolute measurements of power spectra, which makes statistical differences hard to achieve. Transfer function and coherence analysis have been developed as methods to quantify the frequency dependent covariation of MAP and CBF.…”

Decoupling the influence of systemic variables in the peripheral and cerebral haemodynamics during ECMO procedure by means of oblique and orthogonal subspace projections

“…Ejike et al reported no significant correlation between changes in ECMO flow and regional oxygen saturation (rScO 2 ) and a negative correlation between rScO 2 and pCO 2 . Papademetriou et al described oscillations in brain and peripheral haemodynamics during changes in ECMO flow, as measured with near-infrared spectroscopy (NIRS), and its use as a marker of cerebral autoregulation [3,4]. Studies about the coupling between systemic and haemodynamic variables have been performed by means of regression models [2,,5].…”

Regional cerebral oxygenation measured by multichannel near-infrared spectroscopy (optical topography) in an infant supported on venoarterial extracorporeal membrane oxygenation

“…In a previous study we used dual-channel NIRS in patients undergoing ECMO to understand cerebral and peripheral tissue oxygenation 5 . Power spectral density analysis was performed to extract vasomotion and respiratory and cardiac oscillations.…”