Correlation of brain tissue oxygen tension with cerebral near-infrared spectroscopy and mixed venous oxygen saturation during extracorporeal membrane oxygenation

Abstract

The aim of this prospective, animal study was to compare brain tissue oxygen tension (PbtO₂) with cerebral near infrared spectroscopy (NIRS) and mixed venous oxygen saturation (SVO₂) during venoarterial extracorporeal membrane oxygenation (VA ECMO) in a porcine model. This was accomplished using twelve immature piglets with surgically implanted catheters placed in the superficial cerebral cortex to measure brain PbtO₂ and microdialysis metabolites. The NIRS sensor was placed overlying the forehead to measure cerebral regional saturation index (rSO₂i) while SVO₂ was measured directly from the ECMO circuit. Animals were placed on VA ECMO followed by an initial period of stabilization, after which they were subjected to graded hypoxia and recovery. Our results revealed that rSO₂i and SVO₂ correlated only marginally with PbtO₂ (R²=0.32 and R²=0.26, respectively) while the correlation between rSO₂i and SVO₂ was significantly stronger (R²=0.59). Cerebral metabolites and rSO₂i were significantly altered during attenuation of PbtO₂, p<0.05). A subset of animals, following exposure to hypoxia, experienced markedly delayed recovery of both rSO₂i and PbtO₂ despite rapid normalization of SVO₂. Upon further analysis, these animals had significantly lower blood pressure (p=0.001), lower serum pH (p=0.01), and higher serum lactate (p=0.02). Additionally, in this subgroup, rSO₂i correlated better with PbtO₂ (R²=0.76). These findings suggest that, in our ECMO model, rSO₂i and SVO₂ correlate reasonably well with each other, but not necessarily with brain PbtO₂ and that NIRS-derived rSO₂i may more accurately reflect cerebral tissue hypoxia in sicker animals.

Keywords

extracorporeal membrane oxygenation ECMO near-infrared spectroscopy NIRS regional saturation rSO2i mixed venous saturation SVO2 brain tissue oxygen tension PbtO2.

Get full access to this article

View all access options for this article.

References

Van Heijst A. , Liem D. , Hopman J. , et al. Oxygenation and hemodynamics in left and right cerebral hemispheres during induction of veno-arterial extracorporeal membrane oxygenation. J Pediatrics 2004; 144: 223-228.

Ejike JC , Schenkman KA , Seidel K. , et al. Cerebral oxygenation in neonatal and pediatric patients during venoarterial extracorporeal life support. Pediatr Crit Care Med 2006; 7: 154-158.

Wolfberg AJ , du Plessis, AJ Near-infrared spectroscopy in the fetus and neonate. Clin Perinatology 2006; 33: 707-728.

Sakamoto T. , Hatsuoka S. , Stock UA , et al. Prediction of safe duration of hypothermic circulatory arrest by near-infrared spectroscopy. J Thorac Cardiovasc Surg 2001; 122: 339-350.

Rais-Bahrami K. , Rivera O. , Short BL Validation of a noninvasive neonatal optical cerebral oximeter in veno-venous ECMO patients with a cephald catheter. J Perinatology 2006; 26:628-635.

Bulas DI , Glass P. , O’Donnell RM , et al. Neonatal treated with ECMO: predictive value of early CT and US neuroimaging findings on short-term neurodevelopmental outcomes. Radiology 1995; 195: 407-421.

Mendoza JC , Shearer LL , Cook LN Lateralization of brain lesions following extracorporeal membrane oxygenation . Pediatrics 1991; 88: 1004-1009.

Scheufler KM , Rohrborn HJ , Zentner J.

Does tissue oxygen tension reliably reflect cerebral oxygen delivery and consumption?

Anesth Analg 2002; 95(4): 1042-1048.

Tisdall MM , Smith M. Cerebral microdialysis: research technique or clinical tool. Br J Anaesth 2006; 97: 18-25.

10.

Hillered L. , Vespa PM , Hovda DA Translational neuro-chemical research in acute human brain injury: the current status and potential future for cerebral microdialysis . J Neurotrauma 2005; 22: 3-41.

11.

Hlatky R. , Robertson CS Multimodality monitoring in severe head injury. Curr Opin Anaesthesiol 2002; 15: 489-493.

12.

Stiefel MF , Udoetuk JD , Spiotta AM , et al. Conventional neurocritical care and cerebral oxygenation after traumatic brain injury. J Neurosurg 2006; 105: 568-575.

13.

Cua CL , Hoffman TM , Taeed R. , et al. Cerebral saturation trend with mixed venous saturation in patients undergoing extracorporeal life support. Perfusion 2004; 19: 171-176.

14.

Fenik JC , Rais-Bahrami K. Neonatal cerebral oximetry monitoring during ECMO cannulation. J Perinatology 2009; 29: 376-381.

15.

Liem KD , Hopman JCW , Oeseburg B. , et al. Cerebral oxygenation and hemodynamics during induction of extracorporeal membrane oxygenation as investigated by near infrared spectrophotometry. Pediatrics 1995; 95: 555-557.

16.

Manley GT , Pitts LH , Morabito D. , et al. Brain tissue oxygenation during hemorrhagic shock, reuscitation, and alteration in ventilation. J Trauma 1999 ; 46(2): 261-267.

17.

Hunter CJ , Blood AB , Bishai JM , et al. Cerebral blood flow and oxygenation during venoarterial and venovenous extracorporeal membrane oxygenation in the newborn lamb. Pediatr Crit Care Med 2004; 5: 475-481.

18.

Kurth CD , Levy WJ , McCann J. Near-infrared spectroscopy cerebral oxygen saturation thresholds for hypoxia-ischemia in piglets. J Cereb Blood Flow Metab 2002; 22: 335-341.

19.

Dent CL , Spaeth JP , Jones BV , et al. Brain magnetic resonance imaging abnormalities after the Norwood procedure using regional cerebral perfusion. J Thorac Cardiovasc Surg 2005; 130: 1523-1530.

20.

Phelps HM , Mahle WT , Kim D. , et al. Postoperative cerebral oxygenation in hypoplastic left heart syndrome after the Norwood procedure. Ann Thorac Surg 2009 May; 87(5): 1490-1494.

21.

Fraser CD , Andropoulos DB Principles of antegrade cerebral perfusion during arch reconstruction in newborn/ infants. Semin Thorac Cardiovasc Surg Pediatr Card Surg Ann 2008; 11: 61-68.