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Right-sided brain lesions in infants following extracorporeal membrane oxygenation
R E Schumacher1, J D Barks, M V Johnston
1Department of Pediatrics, University of Michigan Medical Center, Ann Arbor.
Insights
Neonatal extracorporeal membrane oxygenation (ECMO) can lead to right-sided brain injuries in infants. Survivors may experience neuromotor deficits, highlighting risks associated with ECMO procedures like carotid artery ligation.
Area of Science:
- Neurology
- Pediatrics
- Neonatology
Background:
- Neonatal extracorporeal membrane oxygenation (ECMO) is a life-support measure for critically ill newborns.
- Potential neurological sequelae following ECMO warrant thorough investigation.
Purpose of the Study:
- To investigate the incidence and characteristics of right hemispheric brain injury in neonatal ECMO survivors.
- To assess the relationship between pre-ECMO conditions and post-ECMO neurological findings.
Main Methods:
- Retrospective review of eight neonatal ECMO survivors with identified brain injury.
- Analysis of pre-ECMO hypoxia/ischemia markers (PaO2, dopamine use, CPR).
- Evaluation of post-ECMO neuroimaging (CT scans) and electroencephalograms (EEGs), alongside neuromotor assessments.
Main Results:
- Five of eight patients experienced significant pre-ECMO hypoxia (PaO2 < 40 mm Hg).
- Seven infants exhibited left-sided, lateralizing neuromotor abnormalities, suggesting right-sided brain injury.
- CT scans revealed right hemispheric abnormalities in three patients, and EEGs showed right-sided slowing/attenuation.
Conclusions:
- Neonatal ECMO is associated with right hemispheric brain abnormalities.
- Neuromotor deficits in survivors often lateralize to the left, indicating contralateral (right) brain injury.
- Carotid artery ligation during ECMO may pose risks for neurological damage.
Abstract:
In retrospective review of survivors of neonatal extracorporeal membrane oxygenation, eight patients with varying degrees of right hemispheric brain injury were identified. The extent of preextracorporeal membrane oxygenation hypoxia and ischemia was documented: five of eight patients had arterial PO2 values of less than 40 mm Hg, seven of eight required dopamine for blood pressure support, and five of eight required cardiopulmonary resuscitation. Two patients had proven neurologic abnormalities before extracorporeal membrane oxygenation. Postextracorporeal membrane oxygenation CT brain scans showed right hemispheric focal abnormalities in three patients. Seven infants had neuromotor abnormalities which were lateralizing in nature; all were left sided, suggesting right-sided brain injury. EEGs showed an increased incidence of slowing and attenuation over the right hemisphere. These findings indicate that right-sided brain abnormalities exist after extracorporeal membrane oxygenation and that carotid artery ligation for extracorporeal membrane oxygenation is not without risk.