Retrospective evaluation of hemodynamic parameters and cerebral near-infrared spectroscopy levels in patients treated with veno-arterial extracorporeal membrane oxygenation

Extracorporeal membrane oxygenation (ECMO) provides advanced bridge therapy for refractory cardiopulmonary failure and perioperative support, including refractory cardiopulmonary resuscitation,⁽⁾ being associated with improved survival and neurological outcomes in these patients.⁽⁾ Neurological complications such as seizures, intracranial hemorrhage, ischemic stroke, cerebral microembolism, among others, are frequently encountered and are important causes of sequelae and functional impairment in these patients.⁽⁾ These complications are more common in V-A ECMO compared to V-V ECMO.⁽⁾ Neurological complications are also more frequent in extracorporeal cardiopulmonary resuscitation (ECPR) compared to ECMO indication in the context of cardiac or respiratory failure.⁽⁾ Considering these complications and the need for constant evaluation of the level of sedation or the emergence of Harlequin syndrome, adequate neurological monitoring in this context is mandatory.^(–)

Methods:

This was a single-center, retrospective cohort study of patients who received support with V-A ECMO and neurological monitoring with cerebral NIRS treated at the Critical Care Department of Hospital Israelita Albert Einstein (HIAE) in São Paulo, SP, during the period from January 2015 until July 2023. Data was extracted from the electronic medical record, EPIMED database of HIAE and ECMO-related database of the Critical Care Department of HIAE. This study was approved by the Research Ethics Committee of Hospital Israelita Albert Einstein. Informed consent was waived due to retrospective design.

Results:

Twenty-three out of 55 V-A ECMO patients (aged 47 [18-70] years) were included. The mean SAPS-3 score on admission was 46.35±12.77. Fifteen individuals (65.2%) were male, and 8 individuals (34.8%) were female. Fifteen patients (65.2%) survived, and 8 patients (34.8%) died. 6 patients (26.1%) were hypertensive. Seven patients (30.4%) had diabetes. 9 patients (39.1%) were cannulated due to cardiogenic shock, 6 (26.1%) due to ECPR, and 8 (34.8%) due to heart or lung transplantation. The mean duration of V-A ECMO treatment was 7.04 days±7.125, with a minimum of 1 day and a maximum of 26 days. The most frequent treatment duration was 4 days (21.7%). The mean ECMO flow was 3.15±0.76. The mean membrane oxygen fraction (FmO2) was 57.29%±18.35. The mean mean arterial pressure (MAP) was 71.59±11.28. The mean left cerebral rSO2 was 52.53±10.41, and right cerebral rSO2 was 52.925±10.45. Multivariate regression analysis showed that mean arterial pressure (MAP) was significantly associated with NIRS levels in both the right (p<0.038) and left (p<0.004) cerebral hemispheres.

Conclusions:

In conclusion, in our retrospective analysis the observed correlation between mean arterial pressure (MAP) and NIRS levels underscores the importance of effective hemodynamic management in maintaining cerebral perfusion during V-A ECMO.

Retrospective evaluation of hemodynamic parameters and cerebral near-infrared spectroscopy levels in patients treated with veno-arterial extracorporeal membrane oxygenation

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