Near-infrared spectroscopy and ultrasound as complementary methods for assessing organ and peripheral tissue perfusion in veno-arterial-ECMO patients.

BACKGROUND

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is vital for stabilizing patients with severe cardiac and pulmonary failure. Effective management requires precise monitoring of organ perfusion and systemic physiologic status. Near-infrared spectroscopy (NIRS) and ultrasound (US) are emerging as key methods of assessment, but their combined utility remains underexplored in VA-ECMO patients.

METHODS

A retrospective analysis was conducted on 267 patients who received VA-ECMO between June 2018 and July 2023. Patients were divided into two groups based on weaning success, defined as survival for more than 48 hours post-weaning with improved cardiac function. Weaning trials involved incremental reductions in VA-ECMO flow, monitored by mean arterial pressure and other clinical measurements. Data including demographics, clinical scores [Glasgow Coma Scale (GCS), Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA)], blood gas indicators, and NIRS and US metrics were collected and analyzed.

RESULTS

Significant differences were observed in cerebral regional oxygen saturation (rSO) dynamics and echocardiographic parameters between the groups. The successful group demonstrated higher maximal ΔrSO (29.57% ± 13.77) than the failure group (25.86% ± 6.39, = 0.003) and a lower minimal rSO (40.67% ± 15.87 vs. 43.9% ± 4.27, = 0.010). Post-ECMO, the successful group exhibited a higher cardiac index (CI, 2.47 L/min/m ± 0.74) compared to the failure group (2.26 L/min/m ± 0.61, = 0.018). Pre-weaning, the successful group displayed lower left ventricular ejection fraction (LVEF, 32.06% ± 4.64) versus the failure group (34.55% ± 8.45, = 0.016), yet post-weaning, it was higher (33.46% ± 4.85) than in the failure group (31.28% ± 7.37, = 0.017). Additionally, the left ventricular outflow tract velocity-time integral (LVOT-VTI) pre-weaning was significantly lower in the successful group (14.95 cm ± 2.98) compared to the failure group (17.35 cm ± 7.22, = 0.006).

CONCLUSION

NIRS and US were found to beconsistent and complementary modalities for assessing perfusion and cardiac function in VA-ECMO patients.