Association of Cerebral Oximetry with Outcomes after Extracorporeal Membrane Oxygenation

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.

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.

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.

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.