title: Cerebral oxygenation in neonatal and pediatric patients during veno-arterial extracorporeal life support.
abstract: OBJECTIVE
  To observe the effects of right carotid artery ligation and variations in extracorporeal life support (ECLS) flow on regional cerebral oxygenation index (rSO2i) measured using near infrared spectroscopy.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Tertiary children's hospital.
  
  
  METHODS
  Eleven neonatal and pediatric patients requiring veno-arterial ECLS support between June 2000 and March 2003.
  
  
  METHODS
  Near infrared spectroscopy probe placement on left and right frontal regions of patients undergoing ECLS, before vessel cannulation or within 24 hrs of initiation of ECLS.
  
  
  RESULTS
  Regional cerebral oxygenation was measured every minute for 72 hrs or until the patient was decannulated. The effect of cannulation on rSO2i from each hemisphere of the brain and the relationship between ECLS flow and rSO2i during ECLS support and "trialing off" periods were determined. Ligation of the right carotid artery resulted in a 12-25% decrease in rSO2i from baseline in the right frontal region for a duration ranging from 17 to 45 mins before returning toward baseline. No substantial change in the left frontal region rSO2i was detected during cannulation. Following this depression in rSO2i on the right, there was a transient increase above baseline in rSO2i observed in both hemispheres on initiating ECLS. No correlation between ECLS flow and rSO2i was found over the 72-hr period. Periods of "trialing off" ECLS were not related to any change in rSO2i in either hemisphere.
  
  
  CONCLUSIONS
  This study demonstrated no relationship between ECLS flow and rSO2i changes during the 72-hr observation period. A brief period of cerebral oxygen desaturation of the right frontal region at the time of right carotid ligation was seen in all three study patients examined during cannulation, followed by an increased rSO2i with initiation of ECLS flow. Near infrared spectroscopy measurement may offer an important adjunct for neurologic monitoring of ECLS patients.
authors.affiliation: Loma Linda University School of Medicine, Loma Linda, CA, USA.
authors.forename: Janeth C
authors.initials: JC
authors.lastname: Ejike
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Schenkman
authors.forename: Kristy
authors.initials: K
authors.lastname: Seidel
authors.forename: Chandra
authors.initials: C
authors.lastname: Ramamoorthy
authors.forename: Joan S
authors.initials: JS
authors.lastname: Roberts
mesh_terms: D001921:Brain / Q000098:blood supply*; D017536:Carotid Artery, Common; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D005625:Frontal Lobe / Q000098:blood supply; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008026:Ligation; D008297:Male; D008991:Monitoring, Physiologic; D010100:Oxygen / Q000097:blood*; D011446:Prospective Studies; D019265:Spectroscopy, Near-Infrared
chemical_list: D010100:Oxygen