title: Resistive Index Variability in Anterior Cerebral Artery Measurements During Daily Transcranial Duplex Sonography: A Predictor of Cerebrovascular Complications in Infants Undergoing Extracorporeal Membrane Oxygenation?
abstract: OBJECTIVE
  The purpose of this study was to determine the value of resistive index (RI) variability in predicting cerebrovascular complications during extracorporeal membrane oxygenation (ECMO).
  
  
  METHODS
  This retrospective study included 36 infants treated by ECMO. The RI was measured on daily transfontanellar duplex sonography, obtained first without fontanel compression and then after gentle compression with the transducer. The age at ECMO cannulation, sex, gestational age at birth, method of delivery, indication, and type and duration of ECMO were recorded.
  
  
  RESULTS
  There was a statistically significant difference in RI variability in infants who developed cerebrovascular complications as opposed to those who did not (P = .002). Resistive index variability of 10% or greater on any day was associated with an increased risk for cerebrovascular complications (P = .0482; χ2= 3.9). Variability in the first 5 days was significantly higher than on following days (P < .0001). The age at ECMO cannulation showed a significant difference, with mean ± SD values of 1.1 ± 0.9 days in the complications group and 2.7 ± 2.2 days in the no-complications group (P = .043).
  
  
  CONCLUSIONS
  Resistive index variability of 10% or greater on any day had a statistically significant risk of cerebrovascular complication development. Extracorporeal membrane oxygenation cannulation at younger than 3 days conferred an increased risk of cerebrovascular complications.
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Science, Division of Pediatric Radiology and Pediatric Neuroradiology, Johns Hopkins University School of Medicine, Baltimore, Maryland USA.|Department of Radiology, Division of Neuroradiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina USA.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Zamora
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Science, Division of Pediatric Radiology and Pediatric Neuroradiology, Johns Hopkins University School of Medicine, Baltimore, Maryland USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Oshmyansky
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland USA.
authors.forename: Melania
authors.initials: M
authors.lastname: Bembea
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland USA.
authors.forename: Ivor
authors.initials: I
authors.lastname: Berkowitz
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Science, Division of Pediatric Radiology and Pediatric Neuroradiology, Johns Hopkins University School of Medicine, Baltimore, Maryland USA.
authors.forename: Eman
authors.initials: E
authors.lastname: Alqahtani
authors.affiliation: Australian Research Council Center of Excellence for Mathematical and Statistical Frontiers, Queensland University of Technology, Melbourne, Victoria, Australia.
authors.forename: Shen
authors.initials: S
authors.lastname: Liu
authors.affiliation: Australian Research Council Center of Excellence for Mathematical and Statistical Frontiers, Queensland University of Technology, Melbourne, Victoria, Australia.
authors.forename: James
authors.initials: J
authors.lastname: McGree
authors.affiliation: Australian Research Council Center of Excellence for Mathematical and Statistical Frontiers, Queensland University of Technology, Melbourne, Victoria, Australia.
authors.forename: Steven
authors.initials: S
authors.lastname: Stern
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Science, Division of Pediatric Radiology and Pediatric Neuroradiology, Johns Hopkins University School of Medicine, Baltimore, Maryland USA.
authors.forename: Thierry A G M
authors.initials: TA
authors.lastname: Huisman
authors.affiliation: Russell H. Morgan Department of Radiology and Radiological Science, Division of Pediatric Radiology and Pediatric Neuroradiology, Johns Hopkins University School of Medicine, Baltimore, Maryland USA atekes1@jhmi.edu.
authors.forename: Aylin
authors.initials: A
authors.lastname: Tekes
mesh_terms: D000367:Age Factors; D020771:Anterior Cerebral Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D002561:Cerebrovascular Disorders / Q000503:physiopathology*; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D017585:Ultrasonography, Doppler, Transcranial; D014655:Vascular Resistance / Q000502:physiology*
keywords: autoregulation; duplex head sonography; extracorporeal membrane oxygenation; infants; pediatric ultrasound; resistive index