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A tale of two bridges: Effect of the bloodless bridge on renal function and blood pressure in neonates managed with venoarterial extracorporeal membrane oxygenation

Massaro, An N. MD; Rais-Bahrami, Khodayar MD; Short, Billie Lou MD

Pediatric Critical Care Medicine: September 2009 - Volume 10 - Issue 5 - p 583-587
doi: 10.1097/PCC.0b013e3181a70418
Neonatal Intensive Care

Objective: To investigate if a change in bridge design of the extracorporeal membrane oxygenation (ECMO) circuit had an impact on renal function and blood pressure in neonates requiring venoarterial ECMO support.

Design: Retrospective chart review.

Setting: A tertiary care neonatal intensive care unit and ECMO center.

Patients: The medical records of neonates admitted to the neonatal intensive care unit and treated with venoarterial ECMO were reviewed. Data were collected on 50 consecutive neonates treated previous to (prebridge group) and following (postbridge group) transition to a new bridge design on the ECMO circuit.

Interventions: None.

Measurements and Main Results: Gestational age, gender, racial distribution, and use of hypertensive therapy were similar between the two groups. Daily blood urea nitrogen, serum creatinine, urine output, fluid balance, and average and maximum systolic and mean arterial blood pressures were recorded for the first 3 days on bypass. The postbridge group had lower maximum mean arterial blood pressure and systolic blood pressure on day 2 of ECMO and lower average mean arterial blood pressure and systolic blood pressure on days 2 and 3 of ECMO. These differences remained significant after controlling for covariates in a multiple regression model. A higher percentage of patients were hypertensive (mean arterial blood pressure >60) in the prebridge group compared with the postbridge group. There were no differences in blood urea nitrogen, serum creatinine, fluid balance, and urine output between the two groups.

Conclusions: Patients managed on venoarterial ECMO after the transition to the “bloodless” bridge had less hypertension compared with those managed before the bridge change. This may reflect improved maintenance of renal perfusion associated with transition to an ECMO bridge design that does not require intermittent circulation with associated arterial-venous shunting.

From the Department of Neonatology, Children’s National Medical Center, WA, DC.

The authors have not disclosed any potential conflicts of interest.

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©2009The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies