Near-infrared spectroscopy predicts brain injury in patients on extracorporeal membrane oxygenation

Abstract

Background: Neurological complications are a leading cause of death in patients on extracorporeal membrane oxygenation (ECMO). Cerebral oxygen saturation monitoring by near infrared spectroscopy (NIRS) may predict neurological injury in ECMO patients. Methods: NIRS was performed routinely on ECMO patients. Data recording clinical neurological signs and head computed tomography (CT) findings were retrospectively collected from medical records. Patients who underwent CT scans were grouped into those with neurological signs and NIRS event (Group A), neurological signs without NIRS event (Group B), NIRS event without neurological signs (Group C), and no neurological sign or NIRS event (Group D). NIRS event was defined as an acute, sustained decrease compared to baseline NIRS value. The incidence and location of neurological injury by CT was evaluated in each group, and the groups were further divided based on clinical neurological sign. Results: A total of 73 patients {groups A [14], B [40], C [0], D [19]} had completed NIRS documentation and 28 patients had CT scans confirming neurological injuries [12 patients (86%) in A, 13 patients (33%) in B, and 3 patients (16%) in D, P=0.006]. Among comatose patients in both group A and B, the sensitivity and specificity in NIRS detecting neurological injury were 59% and 93%, respectively. The sensitivity and specificity of NIRS in detecting neurological injury in the frontal temporal distribution was 81.8% and 78.6% respectively. Conclusions: ECMO patients that developed neurological signs with NIRS event correlated with clinical neurological injury and this was particularly apparent among comatose patients. NIRS was able to detect acute neurological disturbances within expected distributions.