Cerebral oximetry during extracorporeal cardiopulmonary resuscitation
© BioMed Central Ltd. 2013
Published: 28 January 2013
Brain damage remains the most important cause of morbidity and mortality among survivors after cardiac arrest. However, it remains unclear how systemic hemodynamics should be adjusted to ensure adequate cerebral oxygenation. Cerebral oximetry has been used to optimize cerebral perfusion during conventional CPR , and very low cerebral saturation (<40%) may predict poor neurological outcomes at hospital discharge in patients with OHCA . ECMO has been shown to be effective to resuscitate adult patients following refractory cardiac arrest with intact neurological outcomes in 15% to 30% of cases [3, 4]. Nevertheless, only scarce data are available on the adequacy of cerebral oxygenation during eCPR, and most of them focus on pediatric patients. In one retrospective study, Wong and colleagues  described their experience with cerebral oximetry monitoring in 20 adult patients with ECMO; in this population, low cerebral saturation occurred in all patients and was corrected in 80% of them by various interventions to optimize brain perfusion, including increasing MAP or ECMO blood flow . In our patient, cerebral saturation remained very low during CPR and only just exceeded 40% with initial ECMO settings, and both of these factors probably were implicated in the irreversible brain damage.
We suggest that cerebral oximetry be used to rapidly adjust ECMO blood flow to provide adequate brain oxygenation in patients undergoing eCPR. The impact of such an approach on outcomes warrants further evaluation.
extracorporeal membrane oxygenation
extracorporeal cardiopulmonary resuscitation
mean arterial pressure
out-of-hospital cardiac arrest
arterial partial oxygen pressure
- StO2' :
tissue hemoglobin saturation.
We have obtained consent from the patient's family to publish these data.
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