Tags

Type your tag names separated by a space and hit enter

Cerebral blood flow and oxygenation during venoarterial and venovenous extracorporeal membrane oxygenation in the newborn lamb.
Pediatr Crit Care Med. 2004 Sep; 5(5):475-81.PC

Abstract

BACKGROUND

Concern exists that extracorporeal membrane oxygenation (ECMO) may decrease cerebral blood flow (CBF), impair cerebral autoregulation, and thereby increase the risk of neurologic injury.

OBJECTIVE

This study was undertaken in newborn lambs to compare the effects of initiation of venoarterial and venovenous ECMO on CBF and cerebral oxygen delivery as measured by laser-Doppler flowmetry. This study also evaluates the effects of carotid artery and jugular vein ligation on CBF.

DESIGN

CBF, arterial blood pressure, sagittal sinus pressure, heart rate, cardiac output, arterial blood gases, and hemoglobin saturation were measured. After anesthesia, instrumentation, and a 1-2 hr stabilization period, values were recorded during a 30-min control period, and the carotid artery or jugular vein was cannulated. The animals were then studied during venoarterial or venovenous ECMO for 1 hr.

MAIN RESULTS

Carotid ligation resulted in a transient decrease in right cortex CBF that resolved within 60 secs. Next, during a 60-min period of venoarterial ECMO (flow rate of 100 mL.min(-1).kg(-1), n = 11), cerebral resistance to flow increased, CBF decreased 25%, and cerebral oxygen delivery decreased by 30%. Native cardiac output and Paco(2) remained constant. Pulsatility in the lingual artery, representing the pulsatility of arterial flow to the brain, decreased throughout venoarterial ECMO. In contrast, in those lambs receiving ECMO in the venovenous mode (n = 7), resistance to flow, CBF, cerebral oxygen delivery, and pulsatility did not change.

CONCLUSIONS

There was no sustained decrease in CBF after ligation of either the carotid artery or jugular vein. Venoarterial but not venovenous ECMO induced decreases of CBF that could not be attributed to changes in blood gases or blood pressure but that may relate to diminished pulsatility in cerebral resistance vessels or to differences in levels of circulating vasoactive compounds.

Authors+Show Affiliations

Hunter CJ
Center for Perinatal Biology, Loma Linda University School of Medicine, Loma Linda, CA, USA.
Blood AB
No affiliation info available
Bishai JM
No affiliation info available
Hickerson AD
No affiliation info available
Wall DD
No affiliation info available
Peverini RL
No affiliation info available
Power GG
No affiliation info available
Hopper AO
No affiliation info available

MeSH

AnimalsAnimals, NewbornBlood Circulation TimeCerebrovascular CirculationDisease Models, AnimalExtracorporeal Membrane OxygenationHypoxia, BrainJugular VeinsLaser-Doppler FlowmetryLigationMultivariate AnalysisOxygen ConsumptionProbabilityRespiratory InsufficiencySheepUltrasonographyVascular Resistance

Pub Type(s)

Comparative Study
Journal Article
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

15329165

Citation

Hunter, Christian J., et al. "Cerebral Blood Flow and Oxygenation During Venoarterial and Venovenous Extracorporeal Membrane Oxygenation in the Newborn Lamb." Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, vol. 5, no. 5, 2004, pp. 475-81.
Hunter CJ, Blood AB, Bishai JM, et al. Cerebral blood flow and oxygenation during venoarterial and venovenous extracorporeal membrane oxygenation in the newborn lamb. Pediatr Crit Care Med. 2004;5(5):475-81.
Hunter, C. J., Blood, A. B., Bishai, J. M., Hickerson, A. D., Wall, D. D., Peverini, R. L., Power, G. G., & Hopper, A. O. (2004). Cerebral blood flow and oxygenation during venoarterial and venovenous extracorporeal membrane oxygenation in the newborn lamb. Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 5(5), 475-81.
Hunter CJ, et al. Cerebral Blood Flow and Oxygenation During Venoarterial and Venovenous Extracorporeal Membrane Oxygenation in the Newborn Lamb. Pediatr Crit Care Med. 2004;5(5):475-81. PubMed PMID: 15329165.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cerebral blood flow and oxygenation during venoarterial and venovenous extracorporeal membrane oxygenation in the newborn lamb. AU - Hunter,Christian J, AU - Blood,Arlin B, AU - Bishai,John M, AU - Hickerson,Adam D, AU - Wall,Debbie D, AU - Peverini,Ricardo L, AU - Power,Gordon G, AU - Hopper,Andrew O, PY - 2004/8/27/pubmed PY - 2005/1/26/medline PY - 2004/8/27/entrez SP - 475 EP - 81 JF - Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies JO - Pediatr Crit Care Med VL - 5 IS - 5 N2 - BACKGROUND: Concern exists that extracorporeal membrane oxygenation (ECMO) may decrease cerebral blood flow (CBF), impair cerebral autoregulation, and thereby increase the risk of neurologic injury. OBJECTIVE: This study was undertaken in newborn lambs to compare the effects of initiation of venoarterial and venovenous ECMO on CBF and cerebral oxygen delivery as measured by laser-Doppler flowmetry. This study also evaluates the effects of carotid artery and jugular vein ligation on CBF. DESIGN: CBF, arterial blood pressure, sagittal sinus pressure, heart rate, cardiac output, arterial blood gases, and hemoglobin saturation were measured. After anesthesia, instrumentation, and a 1-2 hr stabilization period, values were recorded during a 30-min control period, and the carotid artery or jugular vein was cannulated. The animals were then studied during venoarterial or venovenous ECMO for 1 hr. MAIN RESULTS: Carotid ligation resulted in a transient decrease in right cortex CBF that resolved within 60 secs. Next, during a 60-min period of venoarterial ECMO (flow rate of 100 mL.min(-1).kg(-1), n = 11), cerebral resistance to flow increased, CBF decreased 25%, and cerebral oxygen delivery decreased by 30%. Native cardiac output and Paco(2) remained constant. Pulsatility in the lingual artery, representing the pulsatility of arterial flow to the brain, decreased throughout venoarterial ECMO. In contrast, in those lambs receiving ECMO in the venovenous mode (n = 7), resistance to flow, CBF, cerebral oxygen delivery, and pulsatility did not change. CONCLUSIONS: There was no sustained decrease in CBF after ligation of either the carotid artery or jugular vein. Venoarterial but not venovenous ECMO induced decreases of CBF that could not be attributed to changes in blood gases or blood pressure but that may relate to diminished pulsatility in cerebral resistance vessels or to differences in levels of circulating vasoactive compounds. SN - 1529-7535 UR - https://www.unboundmedicine.com/medline/citation/15329165/Cerebral_blood_flow_and_oxygenation_during_venoarterial_and_venovenous_extracorporeal_membrane_oxygenation_in_the_newborn_lamb_ DB - PRIME DP - Unbound Medicine ER -