Low Postnatal CRI Values Are Associated with the Need for ECMO in Newborns with CDH
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In brief
In brief
Prospective study of 26 CDH newborns demonstrates that Compensatory Reserve Index monitoring can predict ECMO need, with significantly lower CRI values in infants requiring ECMO versus those who stabilized without support. CRI outperformed existing prenatal prognostic measures and may guide clinical decision-making for ECMO initiation.
Written by the GCMD Library team from the article.
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.