Recently, led by Xiangya Hospital of Central South University and Beijing Anzhen Hospital affiliated with Capital Medical University, in collaboration with expert Qian Zhaoxin from the Extracorporeal Life Support Professional Committee of the Chinese Medical Association, and the Intensive Care Medicine Department of Xiangya Hospital of Central South University, Hunan Provincial Clinical Research Center for Geriatric Diseases (Xiangya), Changsha 410008, China; Hou Xiaotong, from the Critical Care Center of the Department of Cardiology at Beijing Anzhen Hospital affiliated with Capital Medical University, Beijing 100029, co authored the "Chinese Expert Consensus on Extracorporeal Membrane Oxygenation Brain Monitoring", which was published in the 9th issue of Volume 109 of the Chinese Medical Journal in 2024.
Extracorporeal membrane oxygenation (ECMO) is an advanced life support technology that temporarily replaces the function of the heart and/or lungs, buying time for their recovery.During ECMO treatment, patients often face various brain injuries such as hypoperfusion, cerebral edema, stroke, and even brain death due to its special physiological effects and possible complications. The brain injury that occurs during ECMO treatment can involve multiple dimensions, including changes in cerebral hemodynamics, dysfunction of cerebral vascular autoregulation, abnormal brain electrophysiologyImbalance of cerebral oxygen supply and oxygen consumptionTherefore, brain monitoring needs to be conducted from different perspectives. Multimodal brain monitoring refers to the use of techniques such as neurological physical examination, plasma brain injury biomarkers, cranial imaging, intracranial pressure (ICP), cerebral blood flow, cerebral oxygen, electroencephalography, and somatosensory evoked potentials to monitor and evaluate patients' brain injuries. Multimodal brain monitoring can achieve: (1) comprehensive assessment of brain functional status. If cerebral blood flow monitoring can reflect the state of cerebral hemodynamics, and electroencephalogram can reflect brain electrical activity,Brain oxygen saturation can reflect the balance of brain oxygen supply and oxygen consumptionMulti dimensional comprehensive evaluation can more comprehensively and accurately reflect the patient's brain injury situation; Timely detection of brain injury.The article points out in the seventh monitoring content of cerebral oxygen monitoring that:Cerebral oxygen monitoring reflects the balance of cerebral oxygen supply and oxygen consumption in ECMO patients，The main bedside monitoring indicators include jugular venous oxygen saturation (SjvO2), partial pressure of brain tissue oxygen (PbtO2), and regional tissue oxygen saturation (rSO2). Due to the invasive monitoring methods of SjvO2 and PbtO2, their application in ECMO patients is limited.Most ECMO patients use rSO2 to reflect overall cerebral oxygen status, and near-infrared spectroscopy (NIRS) is the most widely used for monitoring.
Different NIRS instruments have different algorithms and normal reference ranges, so the trend of rSO2 changes is more important in clinical practice. A retrospective observational study found that the average rSO2 decreased from 61%+11% to 51%+10% during atrial fibrillation, and from 67%+9% to 58%+10% during ventricular fibrillation, suggesting that changes in rSO2 may reflect cerebral perfusion impairment. It is generally believed that a decrease of 15% to 25% or an absolute value below 50% in rSO2 compared to baseline levels indicates cerebral hypoperfusion. VAECMO patients with brain injury are more likely to experience reduced rSO2 and asymmetry of rSO2 between the left and right hemispheres, and rSO2<60% is independently associated with in-hospital mortality. After cardiopulmonary resuscitation, patients may develop cerebral hyperperfusion syndrome, in which rSO2 increases by 10% compared to baseline, which is the threshold for detecting hyperperfusion.Emphasize in the recommendation:ECMO patients who are at risk of brain injury or already have brain injury are recommended to undergo routine monitoring of cerebral oxygen, and NIRS monitoring of rSO2 is recommended (moderate recommendation, evidence level II).The Bolian Zhongke MOC series brain tissue oxygen saturation monitor can provide continuous, real-time, and non-invasive monitoring values of tissue oxygen saturation (rSO2), which can reflect specific organs (such as the brain, abdomen, mesentery, kidney area, or other specific locations) and systemic perfusion status. Research has shown that rSO2 monitoring can detect tissue perfusion damage in the early stages, sensitively reflect tissue oxygenation status, and intervene accordingly, optimizing the entire clinical treatment management. Especially for major surgeries, long-term support patients, and critically ill patients, it can reduce the incidence of complications during hospitalization, shorten hospitalization time, and improve patient prognosis.
