Effect of Extracorporeal Membrane Oxygenation on Cerebral Blood Flow and Cerebral Oxygen Metabolism in Newborn Sheep

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Abstract
Extracorporeal membrane oxygenation (ECMO) supplies respiratory support to term or near-term infants with respiratory failure. Although infants requiring this therapy may have already sustained significant hypoxia and/or ischemia predisposing them to neurologic injury, the high incidence of neuroimaging abnormalities in the ECMO population raises concerns about the additional neurologic risk associated with the ECMO procedure itself. Our study was undertaken to evaluate the effects of ECMO on the normal neonatal cerebral circulation. Thirteen newborn lambs (1-7 d of age) were placed on normothermic venoarterial ECMO using a silicone membrane oxygenator and roller occlusion pump. Regional brain blood flows, cerebral oxygen consumption, fractional oxygen extraction, and oxygen transport were determined 30 and 120 min after initiation of ECMO. Neither cerebral blood flow (baseline, 60.2 ± 23.6; 30 min, 56.1 ± 18.1; 120 min 56.1 ± 12.9 mL/100 g/min) nor oxygen metabolism (cerebral oxygen consumption: baseline, 4.48 ± 1.48; 30 min, 3.86 ± 1.53; 120 min, 4.10 ± 1.32 mL/100 g/min and oxygen extraction: baseline, 0.52 ± 0.09; 30 min, 0.47 ± 0.14; 120 min, 0.46 ± 0.14 mL/100 g/min) changed after the initiation of ECMO. Regional and left/right blood flow differences were not noted. These findings suggest that in healthy newborn lambs, initiation of ECMO does not alter cerebral blood flow or oxygen metabolism.