ABSTRACT
Intracranial hemorrhage (ICH) remains one of the more common serious complications of extracorporeal membrane oxygenation (ECMO) in neonates. In 1990 this center began routine use of cephalic jugular venous drainage during neonatal ECMO to augment blood return to the ECMO pump and potentially decrease the incidence of ICH by decreasing cerebral venous pressure. Thirty-four ECMO cases utilizing cephalic jugular venous drainage were compared with the previous 34 ECMO cases. The incidence of ICH decreased from 35% (12/34) to 6% (2/34) when neonates without cephalic jugular venous drainage are compared with those being subject to this technique (P < .01). No differences were found between the two groups in gestational age, birth weight, duration of ECMO, survival, platelet counts, activated clotting times, or incidence of other bleeding complications. Cephalic jugular venous drainage during neonatal ECMO appears to be safe and may decrease the incidence of ICH.
Subject(s)
Cerebral Hemorrhage/epidemiology , Extracorporeal Membrane Oxygenation/adverse effects , Jugular Veins , Catheterization, Central Venous/instrumentation , Catheterization, Central Venous/methods , Cerebral Hemorrhage/diagnosis , Cerebral Hemorrhage/etiology , Cerebral Hemorrhage/prevention & control , Chi-Square Distribution , Drainage/instrumentation , Drainage/methods , Extracorporeal Membrane Oxygenation/instrumentation , Extracorporeal Membrane Oxygenation/methods , Extracorporeal Membrane Oxygenation/statistics & numerical data , Humans , Incidence , Infant, Newborn , Missouri/epidemiologyABSTRACT
Cannulation of the cephalic portion of the right internal jugular vein during extracorporeal membrane oxygenation (ECMO) allows for increased venous return flow to the circuit. This procedure also allows access to venous drainage from the brain. We reviewed data from simultaneous blood gases obtained from the cephalic jugular vein and the mixed venous return in 5 neonates during venoarterial ECMO. Cephalic venous pO 2 values were significantly lower than mixed venous pO 2 values (P less than .001). The values for pH and pCO 2 did not vary between the sites. Our experience with 34 infants using cephalic jugular drainage is reviewed. Since the institution of right jugular venous drainage, the intracranial hemorrhage rate in neonates undergoing ECMO at our center has decreased from 34% to 6% (p less than .01).
