Prognostic value of cerebral tissue oxygen saturation during neonatal extracorporeal membrane oxygenation

Abstract

ObjectivesExtracorporeal membrane oxygenation support is indicated in severe and refractory respiratory or circulatory failures. Neurological complications are typically represented by acute ischemic or hemorrhagic lesions, which induce higher morbidity and mortality. The primary goal of this study was to assess the prognostic value of cerebral tissue oxygen saturation (StcO2) on mortality in neonates and young infants treated with ECMO. A secondary objective was to evaluate the association between StcO2 and the occurrence of cerebral lesions.Study designThis was a prospective study in infants < 3 months of age admitted to a pediatric intensive care unit and requiring ECMO support.MeasurementsThe assessment of cerebral perfusion was made by continuous StcO2 monitoring using near-infrared spectroscopy (NIRS) sensors placed on the two temporo-parietal regions. Neurological lesions were identified by MRI or transfontanellar echography.ResultsThirty-four infants <3 months of age were included in the study over a period of 18 months. The ECMO duration was 10±7 days. The survival rate was 50% (17/34 patients), and the proportion of brain injuries was 20% (7/34 patients). The mean StcO2 during ECMO in the non-survivors was reduced in both hemispheres (p = 0.0008 right, p = 0.03 left) compared to the survivors. StcO2 was also reduced in deceased or brain-injured patients compared to the survivors without brain injury (p = 0.002).ConclusionStcO2 appears to be a strong prognostic factor of survival and of the presence of cerebral lesions in young infants during ECMO.

Incidence, Outcome, and Predictors of Intracranial Hemorrhage in Adult Patients on Extracorporeal Membrane Oxygenation: A Systematic and Narrative Review

“…NIRS uses near-infrared light to measure trends in cerebral oxygenation ( 86 ). In neonatal ECMO patients, case series have reported decreased brain tissue oxygenation in patients that later demonstrated cerebral injury on neuroimaging ( 87 ). Only one study has studied cerebral NIRS in adults, finding that cerebral oxygenation significantly responded to hemodynamic intervention and that non-responders were more likely to have ischemic cerebral complications ( 88 ).…”

How to use near-infrared spectroscopy

“…In paediatric patients, there is further evidence. Clair et al published a prospective study in 2017 assessing the prognostic value of cerebral NIRS in 34 infants under 3 months of age on ECMO 27. The mortality in this study was 50% and evaluation of the NIRS data revealed than non-survivors had significantly lower NIRS than survivors.…”

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

“…Second, only patients receiving V-A ECMO were included in our study; thus, conclusions obtained from the current study may not be extrapolated to those with V-V ECMO. However, Clair et al ( 19 ) reported the mean CrSO 2 for the whole time of ECMO support, the duration of CrSO 2 below the threshold of 20% from baseline, and the duration of CrSO 2 <50% were not different in patients with V-V ECMO compared to V-A ECMO. Third, we only compared CrSO 2 values between survivors and non-survivors, as the small sample size is a limitation in adjusting for suspected confounding factors.…”