Intracranial venous system in newborns treated with extracorporeal membrane oxygenation: Doppler US evaluation after ligation of the right jugular vein.

There is little information regarding alterations in cerebral venous flow related to ligation of the right jugular vein in newborns treated with extracorporeal membrane oxygenation (ECMO). The authors performed duplex and color Doppler sonographic evaluations of the intracranial venous system in 23 consecutive newborns during ECMO. The superior sagittal sinus (SSS) was visualized in every newborn, and the left transverse sinus was seen in 14 newborns (61%). The relative contribution of a jugular bulb catheter was evaluated in 16 newborns by measuring average blood flow velocities in the SSS with the catheter open (baseline) and with the catheter temporarily occluded. Occlusion of the catheter resulted in significantly reduced SSS blood flow velocities (P = .01). Persistent reductions in SSS flow velocity were associated with a significantly higher risk of cerebrovascular injury (P = .002). These results show that alterations in cerebral venous drainage are not uncommon in newborns treated with venoarterial ECMO and suggest a possible association between abnormal venous drainage and cerebrovascular injury in these newborns.