Association of Cerebral Oximetry with Outcomes after Extracorporeal Membrane Oxygenation

Po Yang Tsou, Alejandro V. Garcia, Alvin Yiu, Dhananjay M. Vaidya, Melania M. Bembea

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
JournalNeurocritical care
DOIs
StateAccepted/In press - Jan 1 2020

Fingerprint

Extracorporeal Membrane Oxygenation
Oximetry
Nervous System
Pediatrics
Reading
Pediatric Intensive Care Units
Survival
Electronic Health Records
Neuroimaging
Observational Studies
Survivors
Retrospective Studies
Odds Ratio
Oxygen
Morbidity
Mortality

Keywords

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

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

Cite this

Association of Cerebral Oximetry with Outcomes after Extracorporeal Membrane Oxygenation. / Tsou, Po Yang; Garcia, Alejandro V.; Yiu, Alvin; Vaidya, Dhananjay M.; Bembea, Melania M.

In: Neurocritical care, 01.01.2020.

Research output: Contribution to journalArticle

Tsou, Po Yang ; Garcia, Alejandro V. ; Yiu, Alvin ; Vaidya, Dhananjay M. ; Bembea, Melania M. / Association of Cerebral Oximetry with Outcomes after Extracorporeal Membrane Oxygenation. In: Neurocritical care. 2020.
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title = "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.",
keywords = "Cerebral oximetry, Child, Extracorporeal life support, Extracorporeal membrane oxygenation, Neuromonitoring, Outcome assessment",
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AU - Tsou, Po Yang

AU - Garcia, Alejandro V.

AU - Yiu, Alvin

AU - Vaidya, Dhananjay M.

AU - Bembea, Melania M.

PY - 2020/1/1

Y1 - 2020/1/1

N2 - 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.

AB - 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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KW - Child

KW - Extracorporeal life support

KW - Extracorporeal membrane oxygenation

KW - Neuromonitoring

KW - Outcome assessment

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