Cerebral Tissue Regional Oxygen Saturation As A Valuable Monitoring Parameter In Pediatric Patients Undergoing Extracorporeal Membrane Oxygenation

Objective:Brain function monitoring technology for extracorporeal membrane oxygenation（ECMO）support has been developing quite slowly.Our objective was to explore the distribution,variation and volatility of cerebral tissue regional oxygen saturation（CrSO₂）in pediatric patients undergoing ECMO.Methods:Eight patients received venoarterial ECMO（V-A ECMO）were included in our study.All of them accepted continuous CrSO₂monitoring within 12 hours of ECMO initiation until ECMO wean with near-infrared spectroscopy（NIRS）.According to Pediatric Intensive Care Unit（PICU）mortality,all patients were primarily divided into survival and deceased groups.Differences in the CrSO₂distribution characteristic,the variation trend of daily CrSO₂,and the volatility of CrSO₂ for the first 5days following ECMO initiation were compared between the survival and deceased group.Results:The percentage of time CrSO₂ less than 60%against the whole monitoring time was significantly lower in the survival group in both hemispheres（Right:4.34（IQR 0.39-8.55）%vs 47.45（IQR 36.03-64.52）%,P=0.036;Left:0.40（IQR 0.01-1.15）%vs 30.9（IQR 26.92-49.62）%,P=0.036）.The survival group had significantly higher CrSO₂ on the first 4days（P<0.05,respectively）.Root mean of successive squared differences（RMSSD）,the volatility variable of CrSO₂,was significantly lower in the survival group（Right:3.29±0.79 vs 6.16±0.67,P=0.002;Left:3.56±1.20vs 6.04±1.44,P=0.039）.Conclusion:CrSO₂ can be used as a regular monitoring parameter for the pediatric patients undergoing ECMO.Lower CrSO₂,CrSO₂ less than60%over a longer period of time,and higher fluctuation of CrSO₂ are likely associated with PICU mortality in pediatric patients undergoing V-A ECMO.