Relationship between regional cerebral oxygen saturation and prognosis in patients undergoing veno-arterial extracorporeal membrane oxygenation
Objective To investigate the correlation between cerebral oxygen saturation and prog-nosis in patients receiving veno-arterial extracorporeal membrane oxygenation(VA-ECMO)support.Methods The prospective study was conducted on 91 patients who received VA-ECMO support in the ICU of the Second Affiliated Hospital of Zhengzhou University between September 2020 and June 2022.The pa-tient's families were asked to provide paper-based informed consent immediately after the initiation of VA-ECMO support.For eligible patients,cerebral oxygen saturation monitoring was conducted by placing a NIRS monitoring probe on the patient's forehead to monitor regional cerebral oxygen saturation(rSO2)con-tinuously and dynamically for at least 24 h.The study collected general patient information,vital signs within the first 24 h of ICU admission(heart rate,mean arterial pressure,respiration),laboratory test re-sults(blood routine tests,lactate),instances of multidrug-resistant bacterial infections during ECMO sup-port,and echocardiography findings(left ventricular diameter,ejection fraction).The patients included in the study were divided into a survivor group and a deceased group.Quantitative data were analyzed using the t-test or Mann-Whitney U test,while categorical data were assessed using the chi-square test or Fisher's exact test for group comparisons.Receiver operating characteristic(ROC)curves were plotted,and the area under the curve was compared using the DeLong method.Results No adverse events were observed.The primary etiology of severe shock among patients was acute cardiovascular diseases,such as acute myocardial infarction and heart failure.The mean age of the patients was approximately 54 years.The survival rate among the enrolled patients was approximately 45％(41/91).Deceased patients exhibited significantly lower rSO2 levels compared to surviving patients(51.42％vs.58.24％,P＜0.05).rSO2 was identified as an independent predictor of poor prognosis in VA-ECMO patients,with an area under ROC curve(AUC)of 0.722.The highest sensitivity(58％)and specificity(75.65％)for predicting mortality in VA-ECMO patients was achieved when the cutoff value of rSO2 was 56％.Conclusion Near-infrared spectroscopy can serve as a valuable tool for monitoring cerebral perfusion in VA-ECMO-supported pa-tients,and reduced cerebral oxygen saturation is associated with unfavorable patient prognosis.However,further large-scale studies are required to validate these findings.
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