title: Jugular ligation does not increase intracranial pressure but does increase bihemispheric cerebral blood flow and metabolism.
abstract: OBJECTIVE
  To answer the following questions: a) Does jugular venous ligation (simulating venovenous extracorporeal life support) alter proximal jugular venous pressure, intracranial pressure, hemispheric cerebral blood flow, or cerebral metabolism? b) Does release of ligation reverse these effects? and c) What are the comparative effects of venous ligation alone vs. venous ligation in combination with arterial ligation?
  
  
  METHODS
  Prospective, randomized, laboratory investigation.
  
  
  METHODS
  Multidisciplinary laboratory setting.
  
  
  METHODS
  Sixteen swine, weighing 8.1 to 12.1 kg, 3 to 4 wks of age.
  
  
  METHODS
  Sixteen swine were randomly assigned to two groups, utilizing a random sequence of vessel ligation. Nine swine underwent occlusion of the right internal and external jugular veins alone (venovenous ligation) followed by release of the occlusion and then occlusion of the right common carotid artery and the right internal and external jugular veins together (venoarterial ligation). The remaining seven swine underwent venoarterial ligation, followed by release of the occlusion and then venovenous ligation. In the experimental group in which venovenous ligation was performed first, the 5, and 30-min release periods after ligation were taken to represent the effects of draining the right jugular vein during venovenous extracorporeal life support.
  
  
  RESULTS
  Data were obtained at baseline, 5, and 30 mins after each ligation/release period. Intracranial pressure, right and left internal jugular pressures/flow rates, and cerebral sinus lactate concentrations were measured. Cerebral blood flow was determined using 133Xe clearance methodology, and the cerebral metabolic rate was calculated. There were no significant differences between the ipsilateral internal jugular pressure or extracorporeal life support at 5 or 30 mins after venovenous or venoarterial ligation compared with baseline values or compared with the release of the ligation at 5 or 30 mins. There was a significant increase in right-side (44.7 +/- 2.0 vs. 38.8 +/- 2.4 mL/kg/min; p < .05) and left-side (42.9 +/- 2.3 vs. 38.7 +/- 1.9 mL/kg/min; p < .05) cerebral blood flow 5 mins after venovenous ligation when compared with baseline values. Similarly, after venoarterial ligation, there was a significant increase in right-side (44.6 +/- 2.2 vs. 38.8 +/- 2.4 mL/kg/min; p < .05) and left-side (43.9 +/- 1.5 vs. 38.7 +/- 1.9 mL/kg/min; p < .05) and cerebral blood flow. Cerebral oxygen consumption was significantly increased after venovenous (2.7 +/- 0.2 to 3.2 +/- 0.2 mL/kg/min; p < .05) and venoarterial (2.7 +/- 0.2 to 3.1 +/- 0.2 mL/kg/min; p < .05) ligation at 5 mins after ligation. This increase persisted at the 30-min period and after release of ligation.
  
  
  CONCLUSIONS
  Ligation of the right jugular veins alone (venovenous ligation) or jugular veins and right carotid artery (venoarterial ligation) does not increase jugular venous pressures or intracranial pressure. However, this procedure does increase cerebral blood flow and cerebral oxygen consumption. These findings demonstrate that there is adequate decompression of the venous system by the cerebrovascular system and retrograde decompression during extracorporeal life support appears unwarranted.
authors.affiliation: Department of Anesthesia, Duke Children's Hospital, Duke University Medical Center, Durham, NC, USA.
authors.forename: P J
authors.initials: PJ
authors.lastname: Chai
authors.forename: L A
authors.initials: LA
authors.lastname: Skaryak
authors.forename: R M
authors.initials: RM
authors.lastname: Ungerleider
authors.forename: W J
authors.initials: WJ
authors.lastname: Greeley
authors.forename: F H
authors.initials: FH
authors.lastname: Kern
authors.forename: S R
authors.initials: SR
authors.lastname: Schulman
authors.forename: D R
authors.initials: DR
authors.lastname: Hansell
authors.forename: R L
authors.initials: RL
authors.lastname: Auten
authors.forename: S F
authors.initials: SF
authors.lastname: Mahaffey
authors.forename: J N
authors.initials: JN
authors.lastname: Meliones
mesh_terms: D000818:Animals; D001784:Blood Gas Analysis; D001794:Blood Pressure; D001921:Brain / Q000378:metabolism*; D002339:Carotid Arteries / Q000502:physiology; D002560:Cerebrovascular Circulation / Q000502:physiology*; D015199:Extracorporeal Membrane Oxygenation; D006439:Hemodynamics; D007427:Intracranial Pressure; D007601:Jugular Veins / Q000502:physiology*; D008026:Ligation; D011446:Prospective Studies; D013552:Swine