Cerebral blood flow and carbon dioxide reactivity in neonates during venoarterial extracorporeal life support

Jana A. Stockwell, Ricki F. Goldstein, Ross M. Ungerleider, Frank H. Kern, Jon N. Meliones, William J. Greeley

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Objectives: a) To determine if cerebral blood flow is symmetric after internal carotid artery and ipsilateral internal jugular vein ligation in infants during venoarterial extracorporeal life support, b) To determine the cerebral CO2 reactivity (A cerebral blood flow/Δ torr CO2) of neonates during venoarterial extracorporeal life support and its correlation to neurodevelopmental outcome. Design: Prospective, clinical study. Setting: University hospital pediatric intensive care unit. Patients: Fourteen neonates with respiratory failure who were receiving venoarterial extracorporeal life support. Interventions: Paco2 was altered by adjusting the CO2 gas flow through the membrane oxygenator. Cerebral blood flow was measured over both parietal-temporal regions at three Paco2 values using xenon-133 clearance methodology. Cerebral blood flow measurements were made early (≤12 hrs of extracorporeal life support, n = 10) or late (≥48 hrs of extracorporeal life support, n = 10). In six of 14 infants, both early and late cerebral blood flow rates were measured. Pao2, mean arterial pressure, pump flow rate, and temperature were stable during each study period. Neurodevelopmental outcome was assessed in the neonatal follow-up clinic. Measurements and Main Results: Right and left hemispheric cerebral blood flow rates were significantly correlated with each other during early and late extracorporeal life support (p = .0001; r2 = .91). Overall, hemispheric cerebral blood flow was statistically symmetric. There was no association of CO2 reactivity (A cerebral blood flow/Δ torr Pco2, range 0.04 to 1.36 mL/min/100 g/torr) with short-term neurodevelopmental outcome. Infants with normal neurodevelopmental outcome had variable CO2 reactivity (range 0.04 to 0.67 mL/min/100 g/torr). Normal short-term neurodevelopmental outcome was observed in two infants with cerebral blood flow of <10 mL/min/100 g. Conclusions: Hemispheric cerebral blood flow was symmetric in infants during early and late venoarterial extracorporeal life support. Some subgroups showed a trend toward decreased right hemispheric cerebral blood flow, but the small number of patients limited interpretation of this finding. CO2 reactivity and cerebral blood flow were highly variable in this population, and were not predictive of short-term neurodevelopmental outcome. Stressed neonates with extremely low cerebral blood flow rates may have relatively normal short-term neurodevelopmental outcome after venoarterial extracorporeal life support.

Original languageEnglish
Pages (from-to)155-162
Number of pages8
JournalCritical Care Medicine
Issue number1 SUPPL.
StatePublished - 1996


  • Asphyxia
  • Brain
  • Carbon dioxide
  • Cerebral circulation
  • Cerebrovascular response
  • Hypercapnia
  • Infants
  • Patient outcome assessment
  • extracorporeal membrane oxygenation

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine


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