There are no recommended guidelines for monitoring parameters during venoarterial extracorporeal membrane oxygenation (V-A ECMO). We evaluated whether regional cerebral oxygen saturation (rScO2) could be a monitoring parameter for mortality during V-A ECMO. We retrospectively searched our database for adult patients who underwent V-A ECMO between April 2015 and October 2016 and identified 21 patients with rScO2 data. Their baseline and clinical characteristics during the first 7 days (vital signs, arterial blood gas results, ECMO variables, rScO2, Swan-Ganz catheter parameters, transthoracic echocardiography parameters, and outcomes) were collected and evaluated for associations with 28 day mortality. The survivor group (12 patients, 57.1%) had higher rScO2 values and lower lactate levels, compared with the nonsurvivor group (nine cases, 42.9%) during the first 7 days. The areas under the receiver operating characteristics curves were 0.87 for right rScO2 (p < 0.001) and 0.86 for left rScO2 (p < 0.001). The optimal cutoff values for right and left rScO2 were 58% (sensitivity: 78.7%, specificity: 83.3%) and 57% (sensitivity: 80.0%, specificity: 70.8%), respectively. Kaplan–Meier analysis revealed that the risks of 28 day mortality were higher among patients with a right rScO2 of <58% and a left rScO2 of <57%, compared with patients with a right rScO2 of ≥58% and a left rScO2 of ≥57% (both, p < 0.001). We suggest that rScO2 may be used as a monitoring parameter for 28 day mortality among patients undergoing V-A ECMO.
The outcomes of venoarterial extracorporeal membrane oxygenation (V-A ECMO) have improved with its technological improvements and our understanding of the artificial organ. However, there are no recommended guidelines for monitoring parameters during clinical treatment using V-A ECMO. For example, macro-hemodynamic parameters (blood pressure, pulse pressure, and pulse rate) do not necessarily reflect the micro-hemodynamic status, especially the artificial flow created during ECMO, which affects the measured values. Although Bottiroli et al.,1 Li et al.,2 and Park et al.3 have reported that monitoring lactate levels is useful during ECMO management, the required testing is invasive and cannot be monitored continuously. There have been recent reports regarding the usefulness of regional cerebral oxygen saturation (rScO2) for monitoring cases of adult cardiac surgery, noncardiac surgery, sepsis, and resuscitation after cardiac arrest.4,5 Therefore, the current study aimed to evaluate whether rScO2 could be a monitoring parameter for mortality during VA-ECMO compared with mean arterial pressure (MAP) and lactate.