Monitoring distal limb perfusion using near-infrared spectroscopy in patients on intra-aortic balloon pump

Abstract

Background: The application of near-infrared spectroscopy (NIRS) in patients undergoing cardiopulmonary bypass for the purpose of monitoring cerebral perfusion is well known. There have been only a few reports of its use in adult patients undergoing peripheral veno-arterial extracorporeal membrane oxygenation to monitor lower limb perfusion. Aim and Objective: Our study aimed to understand the usefulness of NIRS monitoring for the early detection of reduced distal limb perfusion in patients who were placed on intra-aortic balloon pump (IABP) through femoral artery. Materials and Methods: We prospectively studied the use of NIRS monitoring for the early detection of reduced distal limb perfusion in 36 adult patients, who were supported with IABP between 2018 and 2019 (NIRS group). The decision to reinsert the IABP in the contralateral lower limb was made based on the NIRS system’s regional oxygen saturation (rSO2) values. To compare outcomes, the medical records of 45 adult patients who had previously received IABP without NIRS monitoring (control group) between 2017 and 2018 were reviewed retrospectively. Institutional Ethical Committee Approval was taken ref. no. IEC/39/18 dated January 22, 2018. Results: There was no significant difference between the frequency of reinsertion of IABP in the contralateral lower limb in both groups (P = 0.414). The mean time to reinsertion of IABP in the contralateral lower limb is shorter in the NIRS group (20.6 ± 21.4 vs. 40.0 ± 61.0 h). In the NIRS group, no patients underwent fasciotomy, whereas 13.5% did in the control group (P = 0.030). Conclusion: We believe that NIRS monitoring is an effective and accurate approach for detecting limb ischemia in IABP patients. Its use could lead to the early correction of perfusion deficits, as well as the avoidance of compartment syndrome and limb problems.