Lateralization of brain lesions following extracorporeal membrane oxygenation.

The cranial ultrasound and computed tomography scan films of 180 patients who underwent extracorporeal membrane oxygenation were reviewed. Sixteen patients were considered to have moderate to severe brain lesions. Of these, 6 were ischemic and 10 were hemorrhagic. Five (83.3%) of the 6 ischemic lesions involved the right side and only 1 ischemic injury occurred on the left. Seven (70%) of the 10 hemorrhagic lesions occurred solely or predominantly on the side opposite the carotid ligation and 3 were found on the same side as the ligation. One patient suffered a right temporal hemorrhage following cannulation of the left common carotid artery. There was no predominance of brain lesions for either side when both hemorrhagic and ischemic lesions were combined. These observations implicate alterations in cerebrovascular hemodynamics accompanying carotid ligation and reperfusion in the pathogenesis of central nervous system lesions associated with the extracorporeal membrane oxygenation procedure. It is suggested that systematic classification of brain lesions associated with extracorporeal membrane oxygenation be made to get a better understanding of their pathology.