Cerebral hemodynamics monitoring during extracorporeal membrane oxygenation in piglets

Critically ill neonates are subjected to severe and abrupt hemodynamic imbalances that could cause cerebral damage (e.g., hemorrhage, ischemic events). In this population, the need for cerebral monitoring tools to identify dangerous hemodynamic variations in real-time is paramount. Near-infrared spectroscopy (NIRS) is largely exploited in neonatal intensive care units (NICU) to monitor critically ill patients' cerebral oxygenation. However, the most used NIRS devices exploit continuous wave NIRS (CW NIRS) technique, which is affected by motion artifacts and has low penetration depth compared to other more complex NIRS techniques. Moreover, CW-NIRS does not allow the investigation of tissue perfusion. Thus, in this ongoing study, we tested a hybrid device that combines time-domain NIRS (TD-NIRS) and diffuse correlation spectroscopy (DCS) for monitoring absolute cerebral total hemoglobin concentration (tHb), cerebral tissue oxygen saturation (StO2), and cerebral blood flow index (BFI) of piglets during induced hemodynamic variations. Cerebral hemodynamic variations were induced during extracorporeal membrane oxygenation (ECMO) procedure, simulating four common conditions affecting the cerebral hemodynamics of ill neonates: hypocapnia, hypercapnia, hypotension, and hypertension. We measured 4 piglets, and the preliminary results shown in this study are promising, obtaining hemodynamic variations in accordance with previous findings, and empowering the possibility to exploit hybrid TD-NIRS and DCS devices to assess cerebral health of ill neonates.