Ductus arteriosus with left-to-right shunt during venoarterial extracorporeal membrane oxygenation: effects on cerebral oxygenation and hemodynamics.

ABSTRACT

OBJECTIVE: To investigate the effect on cerebral oxygenation and hemodynamics of a patent ductus arteriosus with left-to-right shunt during venoarterial extracorporeal membrane oxygenation in a lamb model. DESIGN: Prospective intervention study in animals. SETTING: Animal research laboratory of a university medical center. SUBJECTS: Six anesthetized newborn lambs with patent ductus arteriosus and left-to-right shunt, installed on venoarterial extracorporeal membrane oxygenation. INTERVENTIONS: Six lambs of 140 days gestational age were prepared to keep the ductus arteriosus open by infiltration of the vessel wall with formaline 10%. The animals were installed on standard venoarterial extracorporeal membrane oxygenation. With a mechanical occluder, the ductus was closed. MEASUREMENTS AND MAIN RESULTS: Changes of mean arterial blood pressure and carotid artery blood flow were measured simultaneously. Using near infrared spectrophotometry, we calculated changes in cerebral concentration of oxyhemoglobin and deoxyhemoglobin (reflecting changes in cerebral oxygen supply) and total hemoglobin (reflecting changes in cerebral blood volume). Also, cerebral oxygen delivery before and after ductus closure was calculated. Before ductus closure there was a left-to-right shunt with a mean +/- SEM of 41 +/- 20% of total body blood flow. Closure of the ductus resulted in an immediate increase in mean arterial blood pressure and carotid artery blood flow. The concentration of oxyhemoglobin increased and the concentration of deoxyhemoglobin decreased, representing increased cerebral oxygen supply. The concentration of total hemoglobin was unchanged, representing unchanged cerebral blood volume. There was an increase in cerebral oxygen delivery. CONCLUSIONS: In this lamb model, a considerable left-to-right shunt over the ductus during venoarterial extracorporeal membrane oxygenation reduced cerebral circulation and oxygenation.