J Pediatr Surg. 2019 Oct 25. pii: S0022-3468(19)30703-1. doi: 10.1016/j.jpedsurg.2019.09.050. [Epub ahead of print] https://www.ncbi.nlm.nih.gov/pubmed/31679772
Low Postnatal CRI Values Are Associated with the Need for ECMO in Newborns with CDH.
Leopold DK1, Phillips RC2, Shahi N2, Gien J3, Marwan AI4, Kinsella JP3, Mulligan J5, Liechty KW4, Moulton SL6.
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Abstract
INTRODUCTION:
Accurate, real-time technology is needed to predict which newborns with congenital diaphragmatic hernia (CDH) will require ECMO. The Compensatory Reserve Index (CRI) is a noninvasive monitoring technology that continuously trends an individual’s capacity to compensate from normovolemia (CRI = 1) to decompensation (CRI = 0). We hypothesized that postnatal CRI values would be lower in CDH newborns that required ECMO than those who did not require ECMO.
METHODS:
Newborns with a CDH were prospectively monitored with a CipherOx® CRI M1 device. We compared CRI values from delivery to ECMO (ECMO group) versus delivery to clinical stabilization (non-ECMO group).
RESULTS:
Postnatal CRI values were available from 26 newborns. Eight underwent ECMO within 33 h of delivery, and median CRI prior to ECMO was 0.068 (IQR: 0.057, 0.078). Eighteen did not require ECMO. Median CRI from birth to 48 h was 0.112 (IQR: 0.082, 0.15). CRI values were significantly lower in newborns that required ECMO versus those who did not (p = 0.0035). Postnatal CRI had the highest AUC (0.85) compared to other prenatal prognostic measures.
CONCLUSION:
Humans from newborns to adults share elemental features of the pulsatile waveform that are associated with progression to decompensation. CRI may be helpful when deciding when to initiate ECMO.
LEVEL OF EVIDENCE:
Level III.
TYPE OF STUDY:
Diagnostic test.
Copyright © 2019 Elsevier Inc. All rights reserved.
KEYWORDS:
Compensatory reserve index; Congenital diaphragmatic hernia; Extracorporeal membrane oxygenation; PhotoplethysmographyPMID: 31679772 DOI: 10.1016/j.jpedsurg.2019.09.050
