Cerebral Near-Infrared Spectroscopy in Adult Patients Undergoing Veno-Arterial Extracorporeal Membrane Oxygenation

Selene Pozzebon, Aaron Blandino Ortiz, Federico Franchi, Stefano Cristallini, Mirko Belliato, Olivier Lheureux, Alexandre Brasseur, Jean Louis Vincent, Sabino Scolletta, Jacques Creteur, Fabio Silvio Taccone

Research output: Contribution to journalArticle

Abstract

Background: Acute cerebral complications (ACC) of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) are associated with poor long-term neurologic outcome. We described the role of rSO2 monitoring in detecting ACC and desaturations and their relationship with poor outcome when employing VA-ECMO. Methods: Retrospective analysis of patients monitored by cerebral frontal near-infrared spectroscopy (NIRS) (CAS Medical Systems Inc., Branford, CT, USA) during VA-ECMO (November 2008–December 2015). ACC was defined as the presence of stroke and/or brain death, while cerebral desaturation as cortical oxygen tissue saturation (rSO2) < 60%. Results: Fifty-six of 159 VA-ECMO patients (age 55 [36–60] years) were included; 18 (32%) developed ACC and 36 died (64%). Cerebral desaturation occurred in 43 (74%) patients, who had a higher mortality than those without cerebral desaturation (74 vs. 31%). A high sequential organ failure assessment (SOFA) score on the first day of ECMO (OR 1.40 [95% CIs 1.06–1.84]) and the minimum ECMO blood flow during the first 4 days of therapy (OR 3.05 [1.01–9.17]) were independently associated with the occurrence of cerebral desaturation. Cerebral desaturation occurred more frequently in patients with ACC than others (94 vs. 68%); patients with ACC also had a lower minimal rSO2 over time (49 vs. 54%) and more frequently had high right-left rSO2 differences (33 vs. 8%), which were both independent predictors of ACC. The occurrence of cerebral desaturation (OR 7.93 [1.62–38.74]) and high lactate concentrations during the first 4 days of ECMO support (OR 1.22 [1.03–1.46]) was independently associated with hospital mortality. Conclusions: Monitoring of rSO2 could be considered as an interesting tool to monitor the brain of patients on VA-ECMO.

Original languageEnglish
Pages (from-to)94-104
Number of pages11
JournalNeurocritical Care
Volume29
Issue number1
DOIs
Publication statusPublished - 2018

Keywords

  • Brain
  • Cerebral oxygenation
  • ECMO
  • Monitoring
  • NIRS

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

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    Pozzebon, S., Ortiz, A. B., Franchi, F., Cristallini, S., Belliato, M., Lheureux, O., Brasseur, A., Vincent, J. L., Scolletta, S., Creteur, J., & Taccone, F. S. (2018). Cerebral Near-Infrared Spectroscopy in Adult Patients Undergoing Veno-Arterial Extracorporeal Membrane Oxygenation. Neurocritical Care, 29(1), 94-104. https://doi.org/10.1007/s12028-018-0512-1