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Cerebral hemodynamics in infants undergoing extracorporeal membrane oxygenation: further observations
G A Taylor1, B L Short, P Glass
1Department of Radiology, Children's Hospital National Medical Center, Washington, DC 20010.
Insights
Extracorporeal membrane oxygenation (ECMO) significantly alters cerebral blood flow in infants, affecting pulsatility and velocity. These hemodynamic changes during ECMO appear well-tolerated, with no observed correlation to mortality or neurodevelopmental outcomes.
Area of Science:
- Pediatric Neurology
- Cardiovascular Physiology
- Neonatal Intensive Care
Background:
- Infants undergoing extracorporeal membrane oxygenation (ECMO) require careful monitoring of cerebral hemodynamics.
- Understanding blood flow alterations during ECMO is crucial for optimizing patient management and outcomes.
Purpose of the Study:
- To evaluate the impact of ECMO on cerebral blood flow dynamics in infants.
- To assess the relationship between altered cerebral blood flow and clinical outcomes, including mortality and neurodevelopment.
Main Methods:
- Intracranial Doppler ultrasonography was used to examine cerebral blood flow in 64 infants treated with ECMO.
- Serial studies focused on the anterior cerebral artery, middle cerebral arteries (MCAs), and internal carotid arteries (ICAs).
Main Results:
- ECMO initiation caused significant changes in pulsatile flow, flow direction, and mean blood flow velocity.
- Pulsatility decreased in all infants, while mean blood flow velocity increased by 87% in 73% of patients.
- Antegrade flow to the right MCA was maintained despite retrograde flow in the right internal carotid artery (ICA) in some cases.
Conclusions:
- ECMO therapy induces substantial, yet apparently well-tolerated, variations in infant cerebral blood flow.
- No correlation was found between altered cerebral blood flow velocity and mortality, intracranial hemorrhage, or neurodevelopmental outcomes.
Abstract:
Intracranial Doppler ultrasonographic examinations were performed on 64 infants treated with extracorporeal membrane oxygenation (ECMO). Serial studies were performed on the anterior cerebral artery in 55 infants before and during ECMO bypass, and on the middle cerebral arteries (MCAs) and internal carotid arteries (ICAs) on an additional nine infants. The onset of ECMO was associated with changes in character of pulsatile flow, direction of flow, and mean blood-flow velocity. Pulsatility decreased in all patients, and mean blood-flow velocity increased in 73% of patients (mean change from baseline, 87%). Despite retrograde flow in the right ICA in five of nine infants, antegrade flow to the right MCA was preserved in all cases. We found no correlation between alterations in mean blood-flow velocity and overall mortality, frequency of intracranial hemorrhage, and neuro-developmental outcome. These data suggest that wide variations in cerebral blood flow occur with ECMO therapy, and that these changes appear to be well tolerated.