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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 (rSO2) is associated with neurologic outcomes and survival in children on ECMO.

Methods

This was a retrospective observational study of children aged 1 day to 20 years who underwent ECMO with routine cerebral rSO2 monitoring in the pediatric intensive care unit at a single academic center between February 2008 and September 2014. We collected all serial rSO2 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 rSO2 ≤ 50%, 60 (38%) had any rSO2 decline > 20% from baseline, and 26 (17%) had any rSO2 decline > 20% from the reading 1 h prior. Any rSO2 ≤ 50% and any rSO2 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). rSO2 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 rSO2 monitoring during ECMO, rSO2 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.

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Acknowledgements

The authors are thankful to Claire Levine, MS, ELS, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA, for the final editing of the text.

Funding

Research reported in this publication was supported by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health under Award Numbers K23NS076674, R21HD096389 and R01NS106292 (MMB). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Correspondence to Melania M. Bembea.

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Percentage of time cerebral regional oxygen saturation (rSO2) was ≤ 40% during extracorporeal membrane oxygenation (ECMO) distributed by neurologic outcome at hospital discharge. Neurologic outcome was assessed by Pediatric Cerebral Performance Category. Results of the nonparametric test suggested a significant difference in the median percentage of time that rSO2 was ≤ 40% between patients with favorable and unfavorable outcomes (p < 0.001). (TIFF 170 kb)

Percentage of time cerebral regional oxygen saturation (rSO2) was ≤ 50% during extracorporeal membrane oxygenation (ECMO) distributed by neurologic outcome at hospital discharge. Neurologic outcome was assessed by Pediatric Cerebral Performance Category. Results of the nonparametric test suggested a significant difference in the median percentage of time rSO2 was ≤ 50% between patients with favorable and unfavorable outcomes (p < 0.001). (TIFF 170 kb)

Comparison of the time percentage that cerebral regional oxygen saturation (rSO2) was reduced > 20% from the baseline value during extracorporeal membrane oxygenation (ECMO) between patients with favorable and unfavorable neurologic outcome at hospital discharge. Neurologic outcome was assessed by Pediatric Cerebral Performance Category. Results of the nonparametric test suggested a significant difference in the median percentage of time that rSO2 was reduced > 20% from baseline between patients with favorable and unfavorable outcomes (p = 0.008). (TIFF 206 kb)

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Tsou, P., Garcia, A.V., Yiu, A. et al. Association of Cerebral Oximetry with Outcomes after Extracorporeal Membrane Oxygenation. Neurocrit Care (2020). https://doi.org/10.1007/s12028-019-00892-4

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Keywords

  • Cerebral oximetry
  • Child
  • Extracorporeal membrane oxygenation
  • Extracorporeal life support
  • Outcome assessment
  • Neuromonitoring