title: Near-Infrared Spectroscopy Monitoring for Early Detection of Limb Ischemia in Patients on Veno-Arterial Extracorporeal Membrane Oxygenation.
abstract: This study aimed to investigate the effectiveness of near-infrared spectroscopy (NIRS) monitoring for the early detection of limb ischemia in patients who were placed on veno-arterial extracorporeal membrane oxygenation (VA-ECMO) via femoral artery. We prospectively used NIRS monitoring for the early detection of limb ischemia in 28 adult patients, who were supported with peripheral VA-ECMO between August 2013 and August 2014 (NIRS group). A decision to perform distal perfusion catheterization was made in accordance with the regional oxygen saturation (rSO2) values provided by the NIRS system. For the comparison of outcome, the medical records of 36 adult patients who had been previously supported with peripheral VA-ECMO without NIRS monitoring (Control group), between July 2012 and July 2013, were retrospectively reviewed. There was no significant difference between the frequency of distal perfusion in both groups (p = 0.435). The mean time to distal perfusion is shorter in the NIRS group (19.6 ± 21.4 vs. 42.0 ± 69.0 hours). No patient underwent fasciotomy in the NIRS group, while 13.9% did in the control group (p = 0.040). We think that NIRS monitoring is a useful and reliable method for the early detection of limb ischemia in patients undergoing peripheral VA-ECMO. Its application may allow timely correction of perfusion deficits and the prevention of compartment syndrome and limb complications.
authors.affiliation: From the *Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital; †Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, South Korea; and ‡Division of Intensive Care Medicine, Sheikh Khalifa Specialty Hospital, United Arab Emirates.
authors.forename: Dong Jung
authors.initials: DJ
authors.lastname: Kim
authors.forename: Young-Jae
authors.initials: YJ
authors.lastname: Cho
authors.forename: Sang Hon
authors.initials: SH
authors.lastname: Park
authors.forename: Cheong
authors.initials: C
authors.lastname: Lim
authors.forename: Kay-Hyun
authors.initials: KH
authors.lastname: Park
authors.forename: Sanghoon
authors.initials: S
authors.lastname: Jheon
authors.forename: Jun Sung
authors.initials: JS
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D042241:Early Diagnosis; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects; D005121:Extremities / Q000098:blood supply*; D005260:Female; D005263:Femoral Artery; D006801:Humans; D007511:Ischemia / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019265:Spectroscopy, Near-Infrared / Q000379:methods*