Optical Topography to Measure Variations in Regional Cerebral Oxygenation in an Infant Supported on Veno-Arterial Extra-Corporeal Membrane Oxygenation

Abstract

Extracorporeal membrane oxygenation (ECMO) is a rescue therapy for patients with cardio-respiratory failure which exposes the patient to the risk for intracranial injury. We used a 12-channel optical topography system to monitor cerebral oxygenation in a venoarterial (VA) ECMO patient during alterations in the ECMO flows. Changes in oxy-(HbO2), deoxy-(HHb) and total-(HbT) haemoglobin concentrations were measured simultaneously with systemic and ECMO circuit parameters. Decreasing the flows resulted in a decrease in venous (SvO2) and arterial (SpO2) saturations. These were reflected in the haemoglobin data by a significant increase in HHb of varying magnitude across the 12 channels and moderate changes in HbO2 suggestive of cerebral arterial dilation to compensate for the lack of oxygen delivery. In the patient studied here ECMO flows appear to present a significant haemodynamic challenge to cerebral circulation.

Venovenous Versus Venoarterial Extracorporeal Membrane Oxygenation for Adult Patients With Acute Respiratory Distress Syndrome Requiring Precannulation Hemodynamic Support: A Review of the ELSO Registry

“…The primary disadvantages of VA ECMO are increased risk of stroke [9], bleeding [9], renal failure [10], and Harlequin syndrome [15] (selective lower body oxygenation with upper body hypoxia). As a testament to advances in VA ECMO, this study demonstrated a low risk of stroke in both groups and no difference in overall bleeding rates or renal failure, as previously described.…”

Successful case of veno-venous extracorporeal membrane oxygenation in an abdominal trauma patient - A case report -

“…While VV-ECMO provides only respiratory support, VA-ECMO provides hemodynamic support as well as respiratory support. VV-ECMO has a lower risk of bleeding, embolism, acute kidney injury, distal ischemia, and flow competition between the patient's native circulation and ECMO than does VA-ECMO[8][9][10]. In addition, there have been reports of successful use of VV-ECMO in hemodynamically unstable patients with ARDS[11,12].…”

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].…”