Griffin M P, Minifee P K, Landry S H, Allison P L, Swischuk L E, Zwischenberger J B
Department of Pediatrics, University of Texas Medical Branch, Galveston.
J Pediatr Surg. 1992 Jan;27(1):33-5. doi: 10.1016/0022-3468(92)90099-s.
Irreversible ligation of the right common carotid artery and right internal jugular vein is usual in venoarterial extracorporeal membrane oxygenation (ECMO) for treatment of severe respiratory failure in neonates. Vessel ligation with ECMO may magnify risks of cerebral hemorrhage or infarction (CHI) and adversely affect neurodevelopmental outcome. To correlate CHI after ECMO with neurodevelopmental outcome, we reviewed cranial ultrasonography (US) and magnetic resonance imaging (MRI) scans in 22 consecutive neonatal ECMO survivors and compared these with results of Bayley Scales of Infant Development obtained at 3, 6, 12, and 24 months of follow-up. All patients had US, and 19 had MRI. No US or MRI had focal abnormal findings attributable to ECMO; specifically, there was no evidence of CHI. Two infants had generalized cerebral atrophy, and one of these had an abnormal Bayley examination. One infant with a normal MRI had a single right focal seizure 4 days after ECMO. Of 20 infants with Bayley developmental tests at 3 to 30 months of age (mental index range, 72 to 135; motor index range, 71 to 150), only 3 were abnormal. In our experience, the incidence of CHI secondary to ECMO is less than that reported. After ECMO, the absence of intracranial hemorrhage, cerebral infarct, or cerebral atrophy on US or MRI usually correlates with normal short-term neurodevelopmental outcome.
在新生儿严重呼吸衰竭的静脉-动脉体外膜肺氧合（ECMO）治疗中，通常要对右侧颈总动脉和右侧颈内静脉进行不可逆结扎。ECMO相关的血管结扎可能会增加脑出血或脑梗死（CHI）的风险，并对神经发育结局产生不利影响。为了将ECMO后的CHI与神经发育结局相关联，我们回顾了22例连续的新生儿ECMO存活者的头颅超声（US）和磁共振成像（MRI）扫描结果，并将其与在3、6、12和24个月随访时获得的贝利婴儿发育量表结果进行比较。所有患者均进行了US检查，19例进行了MRI检查。没有US或MRI有可归因于ECMO的局灶性异常发现；具体而言，没有CHI的证据。两名婴儿有广泛性脑萎缩，其中一名婴儿贝利检查异常。一名MRI正常的婴儿在ECMO后4天出现单次右侧局灶性癫痫发作。在20名3至30个月龄进行贝利发育测试的婴儿中（智力指数范围为72至135；运动指数范围为71至150），只有3例异常。根据我们的经验，ECMO继发CHI的发生率低于报道的发生率。ECMO后，US或MRI上无颅内出血、脑梗死或脑萎缩通常与正常的短期神经发育结局相关。
