Related Experiment Video
Updated: Apr 28, 2026
How to Administer Near-Infrared Spectroscopy in Critically ill Neonates, Infants, and Children
Published on: August 19, 2020
Impaired Oxygen Delivery Risk Analytics in the 6 Hours Before Extracorporeal Membrane Oxygenation: Single-Center
Edon J Rabinowitz1,2,3, Amy Ouyang3,4, Rejean Guerriero4
1Division of Pediatric Critical Care Medicine, Washington University in St Louis, St Louis, MO.
Insights
Impaired oxygen delivery markers before extracorporeal membrane oxygenation (ECMO) predict infant outcomes. Higher impaired oxygen delivery index (iDo2) levels correlate with adverse neurologic events and mortality.
Area of Science:
- Neonatal intensive care
- Pediatric critical care medicine
- Neurology
Background:
- Extracorporeal membrane oxygenation (ECMO) is a life-support measure for infants with severe cardiorespiratory failure.
- Assessing pre-ECMO physiological status is crucial for predicting outcomes.
- Impaired oxygen delivery is a significant concern in critically ill infants.
Purpose of the Study:
- To evaluate the association between pre-ECMO markers of impaired oxygen delivery, specifically the impaired oxygen delivery index (iDo2), and neurologic outcomes in infants.
- To determine if iDo2 can predict mortality and adverse neurologic events in infants undergoing ECMO.
Main Methods:
- A retrospective cohort study of 47 infants younger than 1 year old who received ECMO between 2013 and 2017.
- iDo2 metrics were calculated at 120-minute intervals in the hours preceding ECMO initiation.
- Primary outcomes included mortality, electroencephalography abnormalities, and head imaging findings; secondary outcomes included brain MRI and Functional Status Score (FSS).
Main Results:
- Overall mortality was 55%.
- Higher iDo2 levels, indicating impaired oxygen delivery, were associated with increased mortality and adverse neurologic outcomes, including abnormal electroencephalography and imaging.
- A logistic regression model incorporating pre-ECMO iDo2 metrics demonstrated good performance in predicting poor outcomes (Area Under Curve = 0.81).
Conclusions:
- Pre-ECMO markers of impaired oxygen delivery, quantified by iDo2, are significantly associated with subsequent infant outcomes.
- These findings suggest that iDo2 metrics could be valuable in clinical decision-making for infants requiring ECMO.
- Prospective validation of iDo2 in clinical decision-support systems is warranted.
Objectives:
We evaluate the association between pre-extracorporeal membrane oxygenation (ECMO) markers of impaired oxygen delivery, as quantified by the impaired oxygen delivery index (iD o2 ; Etiometry, Boston, MA) and neurologic outcomes in infants supported on ECMO.
Design:
A single-center retrospective cohort study using demographic and clinical data along with iD o2 metrics calculated at 120-minute intervals before ECMO initiation. Primary outcomes included mortality, electroencephalography abnormalities, and head imaging findings. The secondary outcomes included brain MRI abnormalities and Functional Status Score (FSS) at discharge.
Setting:
Pediatric ECMO center in North America.
Patients:
We included infants younger than 1 year old who were supported on ECMO between 2013 and 2017. We excluded cases with congenital diaphragmatic hernia or postcardiac surgery ECMO.
Interventions:
None.
Measurements And Main Results:
We identified 47 infants meeting the inclusion criteria. Median (interquartile range [IQR]) age and weight at ECMO initiation were 16 days (IQR, 6-112 d) and 3.3 kg (IQR, 2.8-4.8 kg). The overall mortality was 26 of 47 (55% [95% CI, 41-69%]). Nonsurvival compared with survival was associated with a greater proportion of patients with congenital heart disease ( p = 0.03) and pre-ECMO cardiac arrest ( p = 0.006). Time spent above iD o2 thresholds of 25%, 50%, and 75% increased closer to ECMO initiation. Higher iD o2 dose correlated with adverse neurologic outcomes, including electroencephalography abnormalities and abnormal imaging. Last, a logistic regression model for poor outcome (composite of death and FSS), including the time spent above the three iD o2 thresholds at the three time intervals pre-ECMO, showed classification model performance with an area under the receiver operating characteristic curve 0.81 (95% CI, 0.7-0.92; p = 0.0002).
Conclusions:
Markers of impaired oxygen delivery, such as iD o2 in the 6 hours before ECMO are associated with subsequent outcome. Incorporation of these metrics into clinical decision-support systems need to be prospectively tested and evaluated.
More Related Videos
14:28Non-Invasive Monitoring of Microvascular Oxygenation and Reactive Hyperemia using Hybrid, Near-Infrared Diffuse Optical Spectroscopy for Critical Care
Published on: May 10, 2024
04:36Measurement of Tissue Oxygenation Using Near-Infrared Spectroscopy in Patients Undergoing Hemodialysis
Published on: October 2, 2020
Related Concept Videos
01:19Special considerations while measuring oxygen saturation
Ensuring accuracy in vital sign recordings while prioritizing patient comfort and minimizing anxiety is...
01:17Assessment of Diffusion and Perfusion
The Role of Diffusion in Respiration
Diffusion is the process by which molecules move from an area of higher concentration to an area of lower concentration. In the respiratory system, this...
01:21Acute Respiratory Failure-II
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
01:30Administering Oxygen by Mask
Administering oxygen by mask is a common nursing intervention that provides supplemental oxygen to patients with respiratory distress or chronic lung conditions. This procedure involves delivering oxygen at a specified rate through a face mask connected to an oxygen source.
Equipment
The equipment necessary for this procedure includes:
01:19Respiratory Assessment: Purpose and Indications
Objectives and Importance:
The primary goal of respiratory assessment is to evaluate patients at early risk of clinical deterioration. Since respiratory distress often precedes other signs of declining health, breathing patterns and sounds become a...
01:16Oxygen Delivering System II: Venturi Mask and Transtracheal Oxygen
Venturi Mask
The Venturi mask, named after the Venturi effect, is designed to deliver precise oxygen concentrations. It consists of a large tube with an oxygen inlet that narrows down, causing a pressure drop that pulls air in through adjustable side ports. The mask is a lightweight,...