title: A tale of two bridges: effect of the bloodless bridge on renal function and blood pressure in neonates managed with venoarterial extracorporeal membrane oxygenation.
abstract: OBJECTIVE
  To investigate if a change in bridge design of the extracorporeal membrane oxygenation (ECMO) circuit had an impact on renal function and blood pressure in neonates requiring venoarterial ECMO support.
  
  
  METHODS
  : Retrospective chart review.
  
  
  METHODS
  A tertiary care neonatal intensive care unit and ECMO center.
  
  
  METHODS
  The medical records of neonates admitted to the neonatal intensive care unit and treated with venoarterial ECMO were reviewed. Data were collected on 50 consecutive neonates treated previous to (prebridge group) and following (postbridge group) transition to a new bridge design on the ECMO circuit.
  
  
  METHODS
  None.
  
  
  RESULTS
  Gestational age, gender, racial distribution, and use of hypertensive therapy were similar between the two groups. Daily blood urea nitrogen, serum creatinine, urine output, fluid balance, and average and maximum systolic and mean arterial blood pressures were recorded for the first 3 days on bypass. The postbridge group had lower maximum mean arterial blood pressure and systolic blood pressure on day 2 of ECMO and lower average mean arterial blood pressure and systolic blood pressure on days 2 and 3 of ECMO. These differences remained significant after controlling for covariates in a multiple regression model. A higher percentage of patients were hypertensive (mean arterial blood pressure >60) in the prebridge group compared with the postbridge group. There were no differences in blood urea nitrogen, serum creatinine, fluid balance, and urine output between the two groups.
  
  
  CONCLUSIONS
  Patients managed on venoarterial ECMO after the transition to the "bloodless" bridge had less hypertension compared with those managed before the bridge change. This may reflect improved maintenance of renal perfusion associated with transition to an ECMO bridge design that does not require intermittent circulation with associated arterial-venous shunting.
authors.affiliation: Department of Neonatology, Children's National Medical Center, Washington, DC, USA. anguyenm@cnmc.org
authors.forename: An N
authors.initials: AN
authors.lastname: Massaro
authors.forename: Khodayar
authors.initials: K
authors.lastname: Rais-Bahrami
authors.forename: Billie Lou
authors.initials: BL
authors.lastname: Short
mesh_terms: D001794:Blood Pressure / Q000502:physiology*; D016009:Chi-Square Distribution; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007668:Kidney / Q000098:blood supply / Q000503:physiopathology*; D007677:Kidney Function Tests; D008297:Male; D012189:Retrospective Studies