Cerebral hemodynamics in infants undergoing extracorporeal membrane oxygenation: further observations.

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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 neurodevelopmental outcome. These data suggest that wide variations in cerebral blood flow occur with ECMO therapy, and that these changes appear to be well tolerated.