Association of Cerebral Oximetry with Outcomes after Extracorporeal Membrane Oxygenation

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

doi:10.1007/s12028-019-00892-4

Association of Cerebral Oximetry with Outcomes after Extracorporeal Membrane Oxygenation

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

School of Medicine

Research output: Contribution to journal › Article › peer-review

3 Scopus citations

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 language	English (US)
Pages (from-to)	429-437
Number of pages	9
Journal	Neurocritical care
Volume	33
Issue number	2
DOIs	https://doi.org/10.1007/s12028-019-00892-4
State	Published - Oct 1 2020

Keywords

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

ASJC Scopus subject areas

Critical Care and Intensive Care Medicine
Clinical Neurology

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@article{ec8fbea3cb054415b9298e46802d6110,

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",

author = "Tsou, {Po Yang} and Garcia, {Alejandro V.} and Alvin Yiu and Vaidya, {Dhananjay M.} and Bembea, {Melania M.}",

note = "Publisher Copyright: {\textcopyright} 2020, Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.",

year = "2020",

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doi = "10.1007/s12028-019-00892-4",

language = "English (US)",

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pages = "429--437",

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T1 - Association of Cerebral Oximetry with Outcomes after Extracorporeal Membrane Oxygenation

AU - Tsou, Po Yang

AU - Garcia, Alejandro V.

AU - Yiu, Alvin

AU - Vaidya, Dhananjay M.

AU - Bembea, Melania M.

PY - 2020/10/1

Y1 - 2020/10/1

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.

KW - Cerebral oximetry

KW - Child

KW - Extracorporeal life support

KW - Extracorporeal membrane oxygenation

KW - Neuromonitoring

KW - Outcome assessment

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JO - Neurocritical care

JF - Neurocritical care

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Association of Cerebral Oximetry with Outcomes after Extracorporeal Membrane Oxygenation

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