Original Article

Journal of Perinatology (2009) 29, 376–381; doi:10.1038/jp.2008.231; published online 22 January 2009

Neonatal cerebral oximetry monitoring during ECMO cannulation

Presented in part at the American Pediatric Society Annual Meting, Toronto, Canada, May 2007, and at the American Academy of Pediatrics National Conference and Exhibition, San Francisco, CA. October 2007.

J C Fenik1,2 and K Rais-Bahrami1,2

  1. 1Department of Neonatology, Children's National Medical Center, Washington, DC, USA
  2. 2Department of Neonatology, The George Washington University School of Medicine, Washington, DC, USA

Correspondence: Dr K Rais-Bahrami, Department of Neonatology, Children's National Medical Center, 111 Michigan Avenue, NW, Washington, DC 20010, USA. E-mail: kraisbah@cnmc.org

Received 5 July 2008; Revised 20 October 2008; Accepted 8 December 2008; Published online 22 January 2009.

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Abstract

Objective:

 

Neonates were monitored with a cerebral oximeter before, during, and after cannulation for ECMO to determine the direct effects of ligation of the right internal jugular vein and right carotid artery on cerebral oxygenation.

Study Design:

 

After obtaining informed consent, we used the FORE-SIGHT Cerebral Oximeter (CAS Medical Systems, Branford, CT, USA) to monitor neonates undergoing surgical preparation for veno-arterial (VA) or veno-venous (VV) extracorporeal membrane oxygenation (ECMO).

Result:

 

A total of 17 subjects were monitored pre-ECMO for atleast 48 h after cannulation. Of the 17 subjects, 12 experienced low cerebral tissue oxygen saturation (SctO2) <60% during pre-ECMO surgery, with most exhibiting the lowest SctO2 values between cannulation to the onset of ECMO. Two subjects received cardiopulmonary resuscitation (CPR) during surgery and experienced very low SctO2 (5 and 36%). Pulse oximetry was found to be unreliable during CPR because of diminished pulsatile flow. SctO2 increased above 60% after the onset of ECMO for all subjects and remained stable.

Conclusion:

 

Neonates are vulnerable to SctO2 during the pre-ECMO surgical period.

Keywords:

ECMO, NIRS, brain, cerebral oximetry

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