Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
Department of Kardiotechnik, University Hospital Basel, Basel, Switzerland.
J Intensive Care Med. 2020 Feb;35(2):179-186. doi: 10.1177/0885066617735270. Epub 2017 Oct 15.
Femoral access in extracorporeal life support (ECLS) has been associated with regional variations in arterial oxygen saturation, potentially predisposing the patient to ischemic tissue damage. Current monitoring techniques, however, are limited to intermittent bedside evaluation of capillary refill among other factors. The aim of this study was to assess whether cerebral and limb regional tissue oxygen saturation (rSO) values reflect changes in various patient-related parameters during venoarterial ECLS (VA-ECLS). This retrospective observational study included adults assisted by femorofemoral VA-ECLS. Bifrontal cerebral and bilateral limb tissue oximetry was performed for the entire duration of support. Hemodynamic data were analyzed parallel to cerebral and limb rSO. A total of 23 patients were included with a median ECLS duration of 5 [1-20] days. Cardiac arrhythmias were observed in 12 patients, which was associated with a decreased mean rSO from 61%±11% to 51%±10% during atrial fibrillation and 67%±9% to 58%±10% during ventricular fibrillation (<0.001 for both). A presumably sudden increase in cardiac output due to myocardial recovery (n=8) resulted in a significant decrease in mean cerebral rSO from 73%±7% to 54%±6% and from 69%±9% to 53%±8% for the left and right cerebral hemisphere, respectively (=0.012 for both hemispheres). Also, right radial artery partial gas pressure for oxygen decreased from 15.6±2.8 to 8.3±1.9 kPa (=0.028). No differences were found in cerebral desaturation episodes between patients with and without neurologic complications. In six patients, limb rSO increased from on average 29.3±2.7 to 64.0±5.1 following insertion of a distal cannula in the femoral artery (=0.027). Likewise, restoration of flow in a clotted distal cannula inserted in the femoral artery was necessary in four cases and resulted in increased limb rSO from 31.3±0.8 to 79.5±9.0; =0.068. Non-invasive tissue oximetry adequately reflects events influencing cerebral and limb perfusion and can aid in monitoring tissue perfusion in patients assisted by ECLS.
体外生命支持（ECLS）中的股动脉入路与动脉血氧饱和度的区域性变化有关，这可能使患者容易发生缺血性组织损伤。然而，目前的监测技术仅限于间歇性床边评估毛细血管再充盈等因素。本研究旨在评估脑和肢体区域组织氧饱和度（rSO）值是否反映静脉动脉体外生命支持（VA-ECLS）期间各种与患者相关参数的变化。这项回顾性观察性研究纳入了接受股股 VA-ECLS 辅助的成年人。在整个支持过程中进行双额部脑和双侧肢体组织氧合度测量。血流动力学数据与脑和肢体 rSO 平行分析。共纳入 23 例患者，ECLS 中位时间为 5[1-20]天。12 例患者出现心律失常，与心房颤动时平均 rSO 从 61%±11%降至 51%±10%和室性纤颤时从 67%±9%降至 58%±10%相关（均<0.001）。由于心肌恢复导致心输出量的推测性突然增加（n=8）导致平均脑 rSO 从 73%±7%显著下降至 54%±6%，从左半球 69%±9%下降至 53%±8%，右半球分别为（两者均为 0.012）。此外，右桡动脉部分氧分压从 15.6±2.8 降至 8.3±1.9 kPa（=0.028）。有或无神经并发症的患者之间脑缺氧发作无差异。在 6 例患者中，股动脉内插入远端导管后，肢体 rSO 从平均 29.3±2.7 增加到 64.0±5.1（=0.027）。同样，在 4 例中需要恢复在股动脉中插入的已凝结的远端导管中的血流，这导致肢体 rSO 从 31.3±0.8 增加到 79.5±9.0；=0.068。非侵入性组织血氧饱和度充分反映了影响脑和肢体灌注的事件，并有助于监测 ECLS 辅助患者的组织灌注。
