Li Zhang, Juan Wu, Xueli Ji, Xufeng Chen, Yong Mei, Xihua Huang
{"title":"近红外光谱和超声作为辅助方法评估静脉-动脉- ecmo患者器官和外周组织灌注。","authors":"Li Zhang, Juan Wu, Xueli Ji, Xufeng Chen, Yong Mei, Xihua Huang","doi":"10.62347/UQYS8766","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>Significant differences were observed in cerebral regional oxygen saturation (rSO<sub>2</sub>) dynamics and echocardiographic parameters between the groups. The successful group demonstrated higher maximal ΔrSO<sub>2</sub> (29.57% ± 13.77) than the failure group (25.86% ± 6.39, <i>P</i> = 0.003) and a lower minimal rSO<sub>2</sub> (40.67% ± 15.87 vs. 43.9% ± 4.27, <i>P</i> = 0.010). Post-ECMO, the successful group exhibited a higher cardiac index (CI, 2.47 L/min/m<sup>2</sup> ± 0.74) compared to the failure group (2.26 L/min/m<sup>2</sup> ± 0.61, <i>P</i> = 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, <i>P</i> = 0.016), yet post-weaning, it was higher (33.46% ± 4.85) than in the failure group (31.28% ± 7.37, <i>P</i> = 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, <i>P</i> = 0.006).</p><p><strong>Conclusion: </strong>NIRS and US were found to beconsistent and complementary modalities for assessing perfusion and cardiac function in VA-ECMO patients.</p>","PeriodicalId":7731,"journal":{"name":"American journal of translational research","volume":"17 4","pages":"2629-2641"},"PeriodicalIF":1.7000,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082547/pdf/","citationCount":"0","resultStr":"{\"title\":\"Near-infrared spectroscopy and ultrasound as complementary methods for assessing organ and peripheral tissue perfusion in veno-arterial-ECMO patients.\",\"authors\":\"Li Zhang, Juan Wu, Xueli Ji, Xufeng Chen, Yong Mei, Xihua Huang\",\"doi\":\"10.62347/UQYS8766\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>Significant differences were observed in cerebral regional oxygen saturation (rSO<sub>2</sub>) dynamics and echocardiographic parameters between the groups. The successful group demonstrated higher maximal ΔrSO<sub>2</sub> (29.57% ± 13.77) than the failure group (25.86% ± 6.39, <i>P</i> = 0.003) and a lower minimal rSO<sub>2</sub> (40.67% ± 15.87 vs. 43.9% ± 4.27, <i>P</i> = 0.010). Post-ECMO, the successful group exhibited a higher cardiac index (CI, 2.47 L/min/m<sup>2</sup> ± 0.74) compared to the failure group (2.26 L/min/m<sup>2</sup> ± 0.61, <i>P</i> = 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, <i>P</i> = 0.016), yet post-weaning, it was higher (33.46% ± 4.85) than in the failure group (31.28% ± 7.37, <i>P</i> = 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, <i>P</i> = 0.006).</p><p><strong>Conclusion: </strong>NIRS and US were found to beconsistent and complementary modalities for assessing perfusion and cardiac function in VA-ECMO patients.</p>\",\"PeriodicalId\":7731,\"journal\":{\"name\":\"American journal of translational research\",\"volume\":\"17 4\",\"pages\":\"2629-2641\"},\"PeriodicalIF\":1.7000,\"publicationDate\":\"2025-04-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082547/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American journal of translational research\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.62347/UQYS8766\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q3\",\"JCRName\":\"MEDICINE, RESEARCH & EXPERIMENTAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American journal of translational research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.62347/UQYS8766","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"MEDICINE, RESEARCH & EXPERIMENTAL","Score":null,"Total":0}
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 (rSO2) dynamics and echocardiographic parameters between the groups. The successful group demonstrated higher maximal ΔrSO2 (29.57% ± 13.77) than the failure group (25.86% ± 6.39, P = 0.003) and a lower minimal rSO2 (40.67% ± 15.87 vs. 43.9% ± 4.27, P = 0.010). Post-ECMO, the successful group exhibited a higher cardiac index (CI, 2.47 L/min/m2 ± 0.74) compared to the failure group (2.26 L/min/m2 ± 0.61, P = 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, P = 0.016), yet post-weaning, it was higher (33.46% ± 4.85) than in the failure group (31.28% ± 7.37, P = 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, P = 0.006).
Conclusion: NIRS and US were found to beconsistent and complementary modalities for assessing perfusion and cardiac function in VA-ECMO patients.
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