Association of Cerebral Oximetry with Outcomes after Extracorporeal Membrane Oxygenation

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is associated with neurologic morbidity and mortality. We investigated whether cerebral regional oxygen saturation (rSO(2)) is associated with neurologic outcomes and survival in children on ECMO. METHODS: This was a retrospective observational study of children ages 1 day to 20 years who underwent ECMO with routine cerebral rSO(2) monitoring in the pediatric intensive care unit at a single academic center between February 2008 and September 2014. We collected all serial rSO(2) 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 rSO(2) ≤50%, 60 (38%) had any rSO(2) decline >20% from baseline, and 26 (17%) had any rSO(2) decline >20% from the reading 1 h prior. Any rSO(2) ≤50% and any rSO(2) 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). rSO(2) 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 rSO(2) monitoring during ECMO, rSO(2) 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.