Abstract Body (Do not enter title and authors here): Introduction: Veno-arterial extra-corporeal membrane oxygenation therapy (VA-ECMO) following refractory cardiogenic shock (r-CS) or cardiac arrest (r-CA) is associated with morbidity and mortality. Early prediction of neurologic outcomes is crucial , but data remains limited in the clinical setting.We investigated the prognostic value of regional oxygen saturation (rSO₂), using near infrared spectroscopy (NIRS) for the quantitative measurement of cerebral oxygenation.
Methods: This was an observational cohort study of patients underwent VA-ECMO with routine cerebral rSO₂ monitoring at the early phase following ECMO insertion in the intensive care unit from January 2020 and January 2024.Using NIRS sensors,continuous rSO₂ monitoring was assessed during the first 72 hours. Trends of rSO₂ over time were correlated to 28-day mortality, and the prognostic performance of the rSO₂, alone and in combination with the SAVE score, was evaluated.
Results: A total 87 consecutive patients were studied (59 r-CS/28 r-CA).The SAVE score was -8.67 ± 4.56. The 28-day survival rate was 40.2% (35/87 patients). Non-survivors (n=52) had significantly lower rSO₂ than survivors at all time-points (all p<0.001). Abnormal rSO₂ (<50%, at any time from 24 to 72 hours) was 100% specific for 28-day mortality, with 0% false positives. Adding SAVE score to the rSO₂ provided the best prognostic performance (specificity 100% [95% confidence interval 90-100%], sensitivity 77% [62-89%], area under the ROC curve 0.91).
Conclusions: Quantitative rSO₂ alone had excellent ability to predict a poor outcome from day 1 after VA-ECMO insertion, with no false positives. Combining rSO₂ and SAVE score increased sensitivity of outcome prediction, while maintaining 100% specificity.