Article Abstract

Near-infrared spectroscopy predicts brain injury in patients on extracorporeal membrane oxygenation

Authors: Spencer Liem, Nicholas Cavarocchi, Hitoshi Hirose


Background: Neurological complications are aleading cause of death in patients on extracorporeal membrane oxygenation(ECMO). Cerebral oxygen saturation monitoring by near infrared spectroscopy (NIRS)may predict neurological injury in ECMO patients.
Methods: NIRS was performed routinely on ECMOpatients. Data recording clinical neurological signs and head computedtomography (CT) findings were retrospectively collected from medical records.Patients who underwent CT scans were grouped into those with neurological signsand NIRS event (Group A), neurological signs without NIRS event (Group B), NIRSevent without neurological signs (Group C), and no neurological sign or NIRSevent (Group D). NIRS event was defined as an acute, sustained decreasecompared to baseline NIRS value. The incidence and location of neurologicalinjury by CT was evaluated in each group, and the groups were further dividedbased on clinical neurological sign.
Results: A total of 73 patients {groups A[14], B [40], C [0], D [19]} had completed NIRS documentation and 28 patientshad CT scans confirming neurological injuries [12 patients (86%) in A, 13patients (33%) in B, and 3 patients (16%) in D, P=0.006]. Among comatosepatients in both group A and B, the sensitivity and specificity in NIRSdetecting neurological injury were 59% and 93%, respectively. The sensitivityand specificity of NIRS in detecting neurological injury in the frontal temporaldistribution was 81.8% and 78.6% respectively.
Conclusions: ECMO patients that developedneurological signs with NIRS event correlated with clinical neurological injuryand this was particularly apparent among comatose patients. NIRS was able todetect acute neurological disturbances within expected distributions.