Association of Cerebral Oximetry with Outcomes after Extracorporeal Membrane Oxygenation
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ORIGINAL WORK
Association of Cerebral Oximetry with Outcomes after Extracorporeal Membrane Oxygenation Po‑Yang Tsou1, Alejandro V. Garcia2, Alvin Yiu1, Dhananjay M. Vaidya3 and Melania M. Bembea1* © 2020 Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society
Abstract Background: Extracorporeal membrane oxygenation (ECMO) is associated with neurologic morbidity and mortal‑ ity. 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 Febru‑ ary 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 r SO2 ≤ 50%, 60 (38%) had any r SO2 decline > 20% from baseline, and 26 (17%) had any rSO2 decline > 20% from the reading 1 h prior. Any rSO2 ≤ 50% and any r SO2 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 con‑ founders. The effectiveness of initiating early preventative measures in these high-risk patients needs further study. Keywords: Cerebral oximetry, Child, Extracorporeal membrane oxygenation, Extracorporeal life support, Outcome assessment, Neuromonitoring Introduction Extracorporeal life support (ECLS) provides cardiopulmonary support for patients with severe cardiac or respiratory failure that is refractory to conventional *Correspondence: [email protected] 1 Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 1800 Orleans Street, Suite 6321, 21287 Baltimore, MD, USA Full list of author information is available at the end of the article
treatment [1]. The number of neonatal and pediatric ECLS cases reported to the Extracorporeal Life Support Organization (ELSO) registry increased from 2409 at 157 center
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