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Master Thesis

Bénéfice du monitorage non-invasif de l'oxymétrie cérébrale pour le sevrage d'une assistance cardio-circulatoire par ECMO veino-artérielle périphérique : étude prospective descriptive

Abstract : Introduction: Adult postcardiotomy cardiogenic shock potentially requires mechanical circulatory support by veno-arteriel Extracorporeal Membrane Oxygenation (VA ECMO). Circulatory support by ECMO provides prolonged cardiac and respiratory life support, allowing myocardial recovery or bridging to cardiac transplantation or the implantation of a left ventricle assist device (LVAD), but is associated with many risks and complications, including infectious, hemorrhagic and ischemic events. Hence, weaning of ECMO should be daily evaluated and performed as soon as possible. Criteria for ECMO weaning are exclusively echocardiographic. Monitoring of cerebral oximetry (rcSO2) by Near-Infrared Spectroscopy technique (NIRS) is a validated technology to assess the cerebral oxygenation. The aim of our study was to evaluate: 1 / rcSO2 variations during heart recovery, and 2 / the benefit of this monitoring to predict of successful weaning from ECMO. Material and Methods: All adults with postcardiotomy cardiogenic shock requiring VA ECMO implantation between March, 1st and April, 30thd 2014 were included. Echocardiographic weaning criteria were daily evaluated from implantation to weaning from ECMO. rcSO2 was monitored continuously during this period (INVOS®System, Somanetics, USA), allowing to monitor variations of rcSO2 (ΔrcSO2) during ECMO flow reduc tion trials to 2.0 L/min. Results: 14 patients aged 65.0 [55.0; 74.5] years were included. The types of surgery were heart transplantation (n=2), left ventricular assist device (n=1), coronary artery bypass grafting (n=3), valve replacement (n=2), combined surgery (n=4), and ascending aorta surgery (n=1). The duration of ECMO support was 8 [6; 9] days. ΔrcSO2 was not different between successful and non-successful weaning trials (-2.0 [-5.7, -2.0] % vs. -3.0 [-6.0; -0.5%] %; p = 0.98). Moreover, there was no significant difference in ΔrcSO2 during daily ECMO flow reduction trials. Only echocardiographic criteria (Left Ventricular Ejection Fraction, Tricuspid Annular Plane Systolic Excursion, S wave) were associated with successful weaning trial. In multivariate analysis, ΔrcSO2 during weaning trial were associated with variations in pulse oximetry and LVEF. Discussion: In this pilot study, variations of rcSO2 observed during weaning trials of VA ECMO were associated with variations in SpO2 and LVEF. Monitoring by NIRS did not provide additional information about ECMO severability compared to the previously reported criteria.
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Master Thesis
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Submitted on : Wednesday, September 30, 2015 - 4:26:37 PM
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Yann Loncar. Bénéfice du monitorage non-invasif de l'oxymétrie cérébrale pour le sevrage d'une assistance cardio-circulatoire par ECMO veino-artérielle périphérique : étude prospective descriptive. Chirurgie. 2015. ⟨dumas-01207367⟩

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