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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Neurol. | doi: 10.3389/fneur.2018.00993

Regional Cerebral Oximetry as an Indicator of Acute Brain Injury in Adults Undergoing Veno-arterial Extracorporeal Membrane Oxygenation – A Prospective Pilot Study

 Imad Khan1*,  Mehboob Rehan2,  Gunjan Parikh3, Christopher Zammit1,  Neeraj Badjatia3, Daniel Herr3, Zachary Kon3, Charles Hogue4 and Michael Mazzeffi3
  • 1School of Medicine and Dentistry, University of Rochester, United States
  • 2Eastern Idaho Regional Medical Center (EIRMC), United States
  • 3School of Medicine, University of Maryland, United States
  • 4Feinberg School of Medicine, Northwestern University, United States

Background:
Regional cerebral oxygen saturation (rScO2) measured by near-infrared spectroscopy (NIRS) can be used to monitor brain oxygenation in extracorporeal membrane oxygenation (ECMO). ECMO patients that develop acute brain injuries (ABIs) are observed to have worse outcomes. We evaluated the association between rScO2 and ABI in venoarterial (VA) ECMO patients.

Methods:
We retrospectively reviewed prospectively-collected NIRS data from patients undergoing VA ECMO from April 2016 to October 2016. Baseline demographics, ECMO and clinical characteristics, cerebral oximetry data, neuroradiographic images, and functional outcomes were reviewed for each patient. rScO2 desaturations were defined as a >25% decline from baseline or an absolute value <40% and quantified by frequency, duration, and area under the curve per hour of NIRS monitoring (AUC rate, rScO2*min/hr). The primary outcome was ABI, defined as abnormalities noted on brain computerized tomography (CT) or magnetic resonance imaging (MRI) obtained during or after ECMO therapy.

Results:
Eighteen of 20 patients who underwent NIRS monitoring while on VA ECMO were included in analysis. Eleven patients (61%) experienced rScO2 desaturations. Patients with desaturations were more frequently female (73% vs. 14%, p=0.05), had acute liver dysfunction (64% vs. 14%, p=0.05), and higher peak total bilirubin (5.2 mg/dL vs. 1.4 mg/dL, p=0.02). Six (33%) patients exhibited ABI, and had lower pre-ECMO Glasgow Coma Scale (GCS) scores (5 vs 10, p=0.03) and higher peak total bilirubin levels (7.3 vs. 1.4, p=0.009). All ABI patients experienced rScO2 desaturation while 42% of patients without ABI experienced desaturation (p=0.04). ABI patients had higher AUC rates than non-ABI patients (right hemisphere: 5.7 vs. 0, p=0.01, left hemisphere: 119 vs. 0, p = 0.06), more desaturation events (13 vs. 0, p=0.05), longer desaturation duration (2:33 vs. 0, p=0.002), and more severe desaturation events with rScO2 < 40 (9 vs. 0, p=0.05). Patients with ABI had lower GCS scores (post-ECMO initiation) before care withdrawal or discharge than those without ABI (10 vs. 15, p = 0.02).

Conclusions:
The presence and burden of cerebral desaturations noted on NIRS cerebral oximetry are associated with secondary neurologic injury in adults undergoing VA ECMO.

Keywords: NIRS (near infrared reflectance spectroscopy), cerebral oximetry, ECMO (extracorporeal membrane oxygenation), Acute brain injury, neurological outcome, Adults'

Received: 09 Aug 2018; Accepted: 05 Nov 2018.

Edited by:

Wengui Yu, University of California, Irvine, United States

Reviewed by:

Minjee Kim, Northwestern University, United States
Yama Akbari, University of California, Irvine, United States  

Copyright: © 2018 Khan, Rehan, Parikh, Zammit, Badjatia, Herr, Kon, Hogue and Mazzeffi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: MD. Imad Khan, School of Medicine and Dentistry, University of Rochester, Rochester, 14642, New York, United States, imad_khan@urmc.rochester.edu