Regional cerebral oxygenation measured by multichannel near-infrared spectroscopy (optical topography) in an infant supported on venoarterial extracorporeal membrane oxygenation (original) (raw)
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Extracorporeal membrane oxygenation (ECMO) is a rescue therapy for patients with cardio-respiratory failure which exposes the patient to the risk for intracranial injury. We used a 12-channel optical topography system to monitor cerebral oxygenation in a venoarterial (VA) ECMO patient during alterations in the ECMO flows. Changes in oxy-(HbO 2 ), deoxy-(HHb) and total-(HbT) haemoglobin concentrations were measured simultaneously with systemic and ECMO circuit parameters. Decreasing the flows resulted in a decrease in venous (SvO 2 ) and arterial (SpO 2 ) saturations. These were reflected in the haemoglobin data by a significant increase in HHb of varying magnitude across the 12 channels and moderate changes in HbO 2 suggestive of cerebral arterial dilation to compensate for the lack of oxygen delivery. In the patient studied here ECMO flows appear to present a significant haemodynamic challenge to cerebral circulation.
Pediatric Research, 2020
BACKGROUND: Extra-corporeal membrane oxygenation (ECMO) is a life-saving intervention for severe respiratory and cardiac diseases. However, 50% of survivors have abnormal neurologic exams. Current ECMO management is guided by systemic metrics, which may poorly predict cerebral perfusion. Continuous optical monitoring of cerebral hemodynamics during ECMO holds potential to detect risk factors of brain injury such as impaired cerebrovascular autoregulation (CA). METHODS: We conducted daily measurements of microvascular cerebral blood flow (CBF), oxygen saturation, and total hemoglobin concentration using diffuse correlation spectroscopy (DCS) and frequency-domain diffuse optical spectroscopy in nine neonates. We characterize CA utilizing the correlation coefficient (DCSx) between CBF and mean arterial blood pressure (MAP) during ECMO pump flow changes. RESULTS: Average MAP and pump flow levels were weakly correlated with CBF and were not correlated with cerebral oxygen saturation. CA integrity varied between individuals and with time. Systemic measurements of MAP, pulse pressure, and left cardiac dysfunction were not predictive of impaired CA. CONCLUSIONS: Our pilot results suggest that systemic measures alone cannot distinguish impaired CA from intact CA during ECMO. Furthermore, optical neuromonitoring could help determine patient-specific ECMO pump flows for optimal CA integrity, thereby reducing risk of secondary brain injury.
2011
Extracorporeal membrane oxygenation is a life support system for infants and children with intractable cardiorespiratory failure. The risk for developing neurological injuries in this group of patients is considerable. The causes are multifactorial and are not yet fully understood. Induction of ECMO involves ligation List of Acronyms ABP arterial blood pressure ADC analogue-to-digital converter ASD arterial septal defects ASO arterial switch operation AV valves artioventricular valves BP blood pressure CA circulatory arrest CaBF Cerebral artery blood flow CBF cerebral blood flow CBFV Cerebral blood flow velocity CDH Congenital diaphragmatic hernia cCyt.aa 3 Cytocrome oxydase CHD congenital heart defects CICU cardiac intensive care unit CMRO 2 cerebral metabolic activity CNS central nervous system CO cardiac output CO 2 carbon dioxide COH Coherence CPB cardiopulmonary bypass CPP cerebral perfusion pressure CPR cardiopulmonary resuscitation CSF cerebrospinal fluid CT
Role of Cerebral Oximetry in Extracorporeal Membrane Oxygenation
Journal of Cardiac Critical Care TSS
Cerebral oximetry, which is based on near-infrared spectroscopy (NIRS) technology, is an optical technique that allows for noninvasive and continuous monitoring of brain oxygenation by determining cerebral tissue blood oxygen saturation. Many research and observational studies were performed with neonates using various types of NIRS/cerebral oximetry monitors. However, no food and drug administration (FDA) approved-cerebral oximeter is available for neonates. Successful validation of cerebral oximetry for the FDA has been done in human adult volunteer studies under protocols in which jugular bulb and arterial blood samples were obtained under different levels of fractional inspired oxygen levels.
A comparison of the monitors INVOS 3100 and NIRO 500 in detecting changes in cerebral oxygenation
Acta Anaesthesiologica Scandinavica, 1999
Background: Measurements of cerebral haemoglobin oxygenation of 2 near-infrared spectroscopy devices (INVOS 3100 and NIRO 500) were compared during and after hypocapnia. Methods: Fifteen awake, healthy volunteers, who hyperventilated to obtain end-tidal CO 2 (EtCO 2) values of approximately 20 mmHg, were studied. During hyperventilation and 8 min thereafter, EtCO 2 , INVOS 3100 (RSO 2 Ωregional cerebral oxygenation) and NIRO 500 recordings (HbO 2 Ωoxyhaemoglobin, HbΩ deoxyhaemoglobin, Hb-diffΩHbO 2-Hb, CtO 2 Ωoxidised cytochrome oxidase aa3) were analysed. Results: Hyperventilation induced a significant decline in EtCO 2 from 30.5 to 14.7 mmHg (P∞0.001) and RSO 2 from 67.1% to 62.7% (PΩ0.025). At hypocapnia, only Hb (π1.61∫0.48 mmol/L; P∞0.001) and Hb-diff (ª3.01∫2.0 mmol/L; P∞0.001) indicated a decline in cerebral haemoglobin oxygenation. Within 8 min after hyperventilation, both EtCO 2 and RSO 2 normalised to values insignificantly different from baseline. In contrast, Hb and Hbdiff remained significantly different (Hb: π2.52∫1.28 mmol/l; 470 P∞0.001, Hb-diff: ª4.31∫4.0 mmol/L; P∞0.001). A correlation with EtCO 2 was found for RSO 2 (RΩ0.35; P∞0.001) and CtO 2 (RΩ0.42; P∞0.001). All volunteers were continuously awake and none presented clinical symptoms of cerebral hypoxia. Conclusion: Changes in cerebral haemoglobin oxygenation state were reflected more accurately by INVOS 3100 than NIRO 500. The cause may be the different technology of the monitors, since INVOS 3100 eliminates the contribution of extracranial oxygenation.
Journal of Perinatology, 2006
Introduction: Cerebral Oximetry is an optical technique that allows for noninvasive and continuous monitoring of brain oxygenation by determining tissue oxygen saturation (SctO 2). In conjunction with pulse oximetry, cerebral oximetry offers a promising method to estimate cerebral venous oxygen saturation (SvO 2). Objective: The aim of this study was to validate the cerebral oximetry measurements with the cerebral oxygen saturation measured from blood drawn in neonates on veno-venous ECMO with existing cephalad catheter with a prototype neonatal cerebral oximeter developed by CAS Medical Systems (Branford, CT, USA). Study design: After obtaining informed consent, neonates undergoing VV-ECMO with cephalad catheterization were monitored by the CAS cerebral oximeter. Cephalad blood samples were periodically obtained to validate the monitor's accuracy. Results: Seventeen neonates were studied with 1718 h of cerebral oximetry data collected. Compared to the reference values, the bias±precision for cerebral oximetry SctO 2 was 0.4±5.1% and derived SvO 2 was 0.6±7.3% Conclusion: We recommend the use of this noninvasive method as an alternative to blood draws for cerebral venous saturation measurements in neonates requiring extracorporeal life support.
Metabolites, 2023
Cardiopulmonary bypass (CPB) provides cerebral oxygenation and blood flow (CBF) during neonatal congenital heart surgery, but the impacts of CPB on brain oxygen supply and metabolic demands are generally unknown. To elucidate this physiology, we used diffuse correlation spectroscopy and frequency-domain diffuse optical spectroscopy to continuously measure CBF, oxygen extraction fraction (OEF), and oxygen metabolism (CMRO 2 ) in 27 neonatal swine before, during, and up to 24 h after CPB. Concurrently, we sampled cerebral microdialysis biomarkers of metabolic distress (lactate-pyruvate ratio) and injury (glycerol). We applied a novel theoretical approach to correct for hematocrit variation during optical quantification of CBF in vivo. Without correction, a mean (95% CI) +53% (42, 63) increase in hematocrit resulted in a physiologically improbable +58% (27, 90) increase in CMRO 2 relative to baseline at CPB initiation; following correction, CMRO 2 did not differ from baseline at this timepoint. After CPB initiation, OEF increased but CBF and CMRO 2 decreased with CPB time; these temporal trends persisted for 0-8 h following CPB and coincided with a 48% (7, 90) elevation of glycerol. The temporal trends and glycerol elevation resolved by 8-24 h. The hematocrit correction improved quantification of cerebral physiologic trends that precede and coincide with neurological injury following CPB.
Pediatric Anesthesia, 2007
We compared two different near-infrared spectrophotometers: cerebral tissue oxygenation index (TOI) measured by NIRO 200 and regional cerebral oxygenation index (rSO 2 ) measured by INVOS 5100 with venous oxygen saturation in the jugular bulb (SjO 2 ) and central SvO 2 from the superior caval vein (SVC) during elective cardiac catheterization in children. Methods: A prospective observational clinical study in 31 children with congenital heart defects in a catheterization laboratory was undertaken. TOI was compared with SjO 2 in the left jugular bulb and with SvO 2 . rSO 2 was compared with SjO 2 from the right jugular bulb and SvO 2 . Linear regression analysis and Pearson's correlation coefficient were calculated and Bland-Altman analyses were performed. Results: Cerebral TOI and SjO 2 were significantly correlated (r = 0.56, P < 0.0001), as well as TOI and SvO 2 with r = 0.74 (P < 0.0001). Bland-Altman plots showed a mean bias of )4.3% with limits of agreement of 15.7% and )24.3% for TOI and SjO 2 and a mean bias of )4.9% with limits of agreement of 10.3% and )20.1% for TOI and SvO 2 . Cerebral rSO 2 and SjO 2 showed a significant correlation (r = 0.83, P < 0.0001) and rSO 2 and SvO 2 showed excellent correlation with r = 0.93 (P < 0.0001). Bland-Altman plots showed a mean bias of )5.2% with limits of agreement of between 8.4% and )18.8% for rSO 2 and SjO 2 and a mean bias of 5.6% with limits of agreement of 13.4% and )2.2% for rSO 2 and SvO 2 . Conclusions: Both near-infrared spectroscopy devices demonstrate a significant correlation with SjO 2 and SvO 2 values; nevertheless both devices demonstrate a substantial bias of the measurements to both SjO 2 and SvO 2 .