ELECTROENCEPHALOGRAPHIC, NEURORADIOLOGIC, AND NEURODEVELOPMENTAL STUDIES IN INFANTS WITH SUBCLAVIAN STEAL DURING ECMO

Color Doppler imaging revealed a subclavian steal-retrograde flow in t he right vertebral artery which shunted blood from the brain's posteri or circulation to the right arm via the subclavian artery-in 17 of 54 infants (31%) during extracorporeal membrane oxygenation (ECMO); right vertebral artery flow returned to antegrade after ECMO and removal of the right common carotid arterial cannula. When subjects with and wit hout a subclavian steal were compared, there were no statistically sig nificant differences in mortality; in the results of neonatal electroe ncephalograms, cranial ultrasound studies, or computed tomography stud ies; or in early neurological development. Blood flow patterns and pea k systolic velocities in the circle of Willis, middle cerebral arterie s, internal carotid arteries, and basilar artery were similar in both groups during ECMO; blood flow velocity in the middle cerebral arterie s was slightly but significantly lower on the right than the left in b oth groups. Our results indicate that increased flow in the left verte bral artery adequately compensated for the effect of a subclavian stea l on the basilar and cerebral circulation. The moderate to marked neon atal electroencephalographic abnormalities commonly occurring during E CMO and the approximately 20% incidence of neurodevelopmental deficits among ECMO survivors remain largely unexplained.