Hyperspectral Imaging : A New Tool In Weaning And Surveillance Of Patients On Ecls
Martin Oberhoffer, Romina Roesch, Andres Beiras Fernandez, Angela Kornberger, Christian Vahl.
Department of Cardiothoracic and Vascular Surgery; University Hospital Mainz, Mainz, Germany.
Weaning patients from extracorporeal life support (ECLS) is usually guided by echocardiography,blood gas analysis,systemic venous saturation(SvO2),lactate levels,near infrared spectroscopy(NIRS) and inotropic support. Hyperspectral imaging (HSI) has proven to be a noninvasive, fast and easy method of determining microvascular tissue oxygenation and perfusion by visualizing hemoglobin oxygenation (StO2), tissue hemoglobin index (THI),near infrared perfusion index (NIR) and tissue water index (TWI). For the first time we acquired data from HIS concomitant to standard hemodynamic parameters while and after weaning a patient from ECLS.
The 62 year old female patient had undergone a Bentall procedure and showed massive pulmonary embolism in the rehabilitation institute 20 days after surgery. Our team was sent of to initiate rescue-ECLS support due to biventricular heart failure. After transferal pulmonary embolectomy was performed. On postoperative day 10 weaning from ECLS was performed guided by standard parameters and parallel the acquisition of HIS images. After 3 hours HIS was repeated and analyzed
Separating ECLS was performed stepwise from 5.5 l/min to 1.2 l/min over a 45 minute period. We observed a tolerable increase of inotropic support accompanied by a slight decrease of StO2 and THI on HIS. NIR and TWI remained unchanged. ECLS was switched to veno-venous extracorporeal membrane oxygenation for further pulmonary support. HIS analysis after 3 hours revealed worsening of StO2, THI,NIR and TWI parallel to hemodynamic deterioration and pulmonary failure. The patient developed severe multiorgan failure and died 12 hours later.
In this first reported case where HSI data were aquired concomitant to standard hemodynamic parameters during and after weaning a severely diseased patient from ECLS we demonstrated that StO2, THI,NIR and TWI clearly reflected hemodynamic conditions of the patient. HSI technique is easy,rapid and noninvasive and could offer a promising tool in patients on ECLS. Further data acquisition and analysis is mandatory to proof the value of HIS in a variety of hemodynamic settings.
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