Abstract
Objective: Venoarterial extracorporeal membrane oxygenation is an effective mechanical circulatory support that is used to rescue critically ill patients after congenital heart surgery. As there was still no recommended guideline for monitoring parameters during extracorporeal membrane oxygenation (ECMO), this study aimed to investigate the role of near-infrared spectroscopy (NIRS) in the early period of venoarterial (VA)-ECMO.Method: This study enrolled patients with NIRS monitoring during ECMO after pediatric cardiac surgery at Shanghai Children's Medical Center (2018–2020). The information obtained from the retrospective, the observational dataset included the demographic information, diagnoses, baseline characteristics, procedural details, ECMO data, monitoring data, in-hospital mortality, and complications of the patients.Results: The overall mortality rate was 43.6%. Lactate was significantly higher in non-survivors compared to survivors at 12 h (11.25 ± 7.26 vs. 6.96 ± 5.95 mmol/l, p = 0.022) and 48 h [2.2 (0.7, 20) vs. 1.4 (0.7, 5.8) mmol/l, p = 0.008] after initiation of ECMO. The cranial regional oxygen saturation (CrSO2) was significantly higher in survivors compared to non-survivors at 24 h (62.5 ± 14.61 vs. 52.05 ± 13.98%, p = 0.028), 36 h (64.04 ± 14.12 vs. 51.27 ± 15.65%, p = 0.005), and 48 h (65.32 ± 11.51 vs. 55.00 ± 14.18%, p = 0.008). Multivariate logistics regression analysis of the hemodynamic and laboratory parameters revealed that the CrSO2 at 36 h (OR = 0.945, p = 0.049) and 48 h (OR = 0.919, p = 0.032) was related to mortality. The use of continuous renal replacement therapy (OR = 14.940, p = 0.039) was also related to mortality. The optimal cutoff values for CrSO2 for predicting mortality after weaning off ECMO at 36 and 48 h were 57% (sensitivity: 61.5%, specificity: 80%) and 56% (sensitivity: 76.9%, specificity: 70%), respectively. The risk of mortality was higher among patients with a CrSO2(36h) < 57% (p = 0.028) by Kaplan-Meier analysis.Conclusion: Near-infrared spectroscopy may be a useful tool for monitoring the hemodynamic stability during the early period of ECMO, while CrSO2 can predict the in-hospital mortality after ECMO.
Highlights
Extracorporeal membrane oxygenation is an effective method for the management of refractory cardiogenic shock [1]
There were some simple cases of congenital heart disease (CHD), such as ventricular septum defect, most of these patients had heart dysfunction or extracardiac problems before the procedure
Palliative surgery was performed in 22% of patients, including three patients with Ebstein’s malformation, two patients with the great arteries (TGA), two with Tetralogy of Fallot, one with pulmonary atresia (PA) with intact ventricular septal, one with PA with VSD, and one patient with a single ventricle
Summary
Extracorporeal membrane oxygenation is an effective method for the management of refractory cardiogenic shock [1]. It is a lifesaving procedure in the event of failure of other conventional therapies. Recent advancements in technology have expanded its applications to more complex diseases, including congenital heart disease (CHD) in children. Extracorporeal membrane oxygenation (ECMO) has been used in increasingly complicated cases of pediatric CHD during the early postoperative risk stage after open heart surgery in recent years. It was reported that up to 2–5% of all children undergoing cardiac surgery require mechanical cardiac support with ECMO during the postoperative period [2]. The clinical management of ECMO presents a huge challenge in children
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