Cerebral near-infrared spectroscopy in perioperative management of left ventricular assist device and extracorporeal membrane oxygenation patients.

PURPOSE OF REVIEW: Neurologic injury remains a common complication in patients undergoing mechanical support for cardiac and respiratory failure with either left ventricular assist devices (LVAD) or extracorporeal membrane oxygenation (ECMO). Cerebral near-infrared spectroscopy (NIRS) has been recognized clinically as a valid, continuous, and practical monitor of cerebral perfusion in cardiac surgery. Recently, interest in utilizing this technology to monitor patients while undergoing LVAD and ECMO placement and their resultant care has expanded. The purpose of this review is to discuss the practical approaches to using cerebral NIRS for LVAD and ECMO implantation. RECENT
FINDINGS: Recent studies suggest that implementation of cerebral NIRS monitoring during LVAD and ECMO implantation may reduce the perioperative neurological complications. In addition, cerebral NIRS can function as a first-alert monitor to warn of problems with oxygenation, ventilation, mixed venous oxygen saturation, and cardiac output.
SUMMARY: Despite an overall small body of literature, early evidence suggests a possible beneficial effect of utilizing cerebral NIRS during LVAD and ECMO implantation. Prospective randomized studies are needed to develop algorithm-based therapies centered on NIRS monitoring. On the basis of potential benefits and minimal risks in relation to cerebral NIRS, it is recommended that it be utilized during the operative and immediate postoperative period in the LVAD and ECMO patient population.