Neonatal cerebral oximetry monitoring during ECMO cannulation.
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.


METHODS
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).


RESULTS
A total of 17 subjects were monitored pre-ECMO for at least 48 h after cannulation. Of the 17 subjects, 12 experienced low cerebral tissue oxygen saturation (SctO(2)) <60% during pre-ECMO surgery, with most exhibiting the lowest SctO(2) values between cannulation to the onset of ECMO. Two subjects received cardiopulmonary resuscitation (CPR) during surgery and experienced very low SctO(2) (5 and 36%). Pulse oximetry was found to be unreliable during CPR because of diminished pulsatile flow. SctO(2) increased above 60% after the onset of ECMO for all subjects and remained stable.


CONCLUSIONS
Neonates are vulnerable to SctO(2) during the pre-ECMO surgical period.
Fenik
J C
JC
Department of Neonatology, Children's National Medical Center, Washington, DC 20010, USA.
Rais-Bahrami
K
K
D001921:Brain / Q000098:blood supply*; D002405:Catheterization, Central Venous; D002560:Cerebrovascular Circulation / Q000502:physiology; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008991:Monitoring, Physiologic; D010092:Oximetry / Q000379:methods*; D010101:Oxygen Consumption / Q000502:physiology; D011336:Probability; D012127:Respiratory Distress Syndrome, Newborn / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D018570:Risk Assessment; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome