We examine the correlation of non-invasive, frequency-domain diffuse optical spectroscopy (FD-DOS) and diffuse correlation spectroscopy (DCS) measurements of cerebral tissue oxygen extraction fraction (OEF) and relative cerebral blood flow (rCBF) with invasive cerebral microdialysis measurement of the cerebral lactate-pyruvate ratio (LPR), a biomarker of metabolic stress, during extracorporeal membrane oxygenation (ECMO) in a pediatric swine model of ECMO assisted cardiopulmonary resuscitation (n=15). During 22-24 hours of ECMO, non-invasive FD-DOS/DCS neuromonitoring of OEF and rCBF demonstrated significant correlations with cerebral LPR. Non-invasive detection of critical neurometabolic stress at the bedside may facilitate brain-targeted ECMO management after cardiac arrest.
Extracorporeal membrane oxygenation (ECMO) is an important therapy for critically ill children but survivors have neurodevelopmental impairments. Cerebral inflammatory response resulting in brain edema is observed on ECMO. This pathologic response may adversely impact the quantitative accuracy of diffuse optical spectroscopy (DOS) neuromonitoring (including commercial NIRS) which commonly assumes a 75% water fraction. Using fresh brain tissue desiccation, we directly quantified the severity of cerebral edema in pediatric swine following cardiac arrest, CPR and 22-24 hours of ECMO therapy. The fractional error in DOS quantification of cerebral hemodynamics from assuming 75% water fraction was determined to be <5%.
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