Comparison of venoarterial versus venovenous access in the cerebral circulation of newborns undergoing extracorporeal membrane oxygenation

This study was designed to compare venoarterial (VA) with venovenous (VV) a ccess in the cerebral circulation of newborn infants during extracorporeal membrane oxygenation (ECMO). Among 14 infants with VA ECMO, 7 had no intrac ranial complications (group 1), while the others (group 2) developed intrac ranial hemorrhage (ICH). In contrast,among 19 infants with VV ECMO, only 1 developed ICH. Serial echocardiograms were performed before and after 1, 6, 12, and 24 h and 2 and 3 days of ECMO.;The mean cerebral blood flow (CBF) velocities were measured in the anterior cerebral artery (ACA), right and l eft internal carotid arteries (Rt, Lt-ICA), basilar artery CBA), and right and left middle cerebral arteries (Rt, Lt-MCA). Ejection fraction (EF), car diac output ((SO), and stroke volume (SV) were also measured using standard echography. The velocity levels in the ACA, Rt-MCA, and Lt-MCA in VA ECMO were lower than those in VV ECMO, while those in the Lt-ICA and BA in VA EC MO were higher than those in VV ECMO. The EF, CO, and SV were lower in case s of VA ECMO than in VV ECMO. In cases of VA ECMO, there were no difference s between groups 1 and 2in velocities in the ACA, Rt-ICA, or Lt-ICA. Howeve r the velocities in group 2 in the BA, Rt-MCA, and Lt-MCA were lower than t hose in group 1 before and during ECMO. Similarly, the EF, CO, and SV were lower in group 2 (12.0%-31.0%, 0.10-0.32 1/min, and 0.66-1.55 mi, respectiv ely) than in group 1 (29.5%-49.3%, 0.5-0.63 1/min, and 2.15-3.85 mi) during ECMO. However, in the infants on VV ECMO the CBF was either maintained or gradually increased before and during ECMO. Their cardiac parameters were: EF 46.1%-53.0%, CO 0.43-0.52 l/min, and SV 2.72-3.84 ml during ECMO. It is concluded that in VA ECMO CBF velocities, particularly in infants who devel oped ICH, decreased after the onset of ECMO in association with poor cardia c function, while in VV ECMO they were stable, probably due to normal syste mic hemodynamic's and cardiac function.