Published online May 5, 2008
PEDIATRICS Vol. 121 No. 6 June 2008, pp. e1599-e1603 (doi:10.1542/peds.2007-2380)
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ARTICLE

Intravascular Volume Administration: A Contributing Risk Factor for Intracranial Hemorrhage During Extracorporeal Membrane Oxygenation?

Amerik C. de Mol, MDa, Luella C. Gerrits, MDa, Arno F. J. van Heijst, MD, PhDa, Huub Straatman, MScb, Frans H. J. M. van der Staak, MD, PhDc and Kian D. Liem, MD, PhDa

a Department of Pediatrics, Division of Neonatology, and Departments of
b Epidemiology and Biostatistics
c Pediatric Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands

OBJECTIVE. The objective of this study was to determine the relationship between the frequency and total volume of intravascular volume administration and the development of intracranial hemorrhage during venoarterial extracorporeal membrane oxygenation.

METHODS. In a retrospective, matched, case-control study, 24 newborns who developed an intracranial hemorrhage during venoarterial extracorporeal membrane oxygenation treatment were compared with 40 control subjects. Both groups were analyzed for gestational age, gender, race, Apgar scores at 1 and 5 minutes, birth weight, cardiopulmonary resuscitation before venoarterial extracorporeal membrane oxygenation, age at the start of treatment, duration of treatment, worst arterial blood gas sample preceding treatment, activated clotting time values, need for platelet transfusions, mean blood pressure, and the use of inotropics and steroids before the treatment. For both groups, total number and volume of intravascular infusions of normal saline, pasteurized plasma protein solution, erythrocytes, and platelets during the first 24 hours of treatment were determined. Variables were analyzed in their relationship to intracranial hemorrhage by using univariate and multivariate conditional logistic regression.

RESULTS. The only statistically significant difference in patient characteristics between the case patients and control subjects was arterial blood gas values. Newborns who developed intracranial hemorrhage during the treatment received both a statistically significantly higher number and a statistically significantly higher total volume of intravascular volume administrations compared with control patients. After adjustment for pH, PaCO2, and PaO2 in the multivariate analysis, we found a significant relation between the development of intracranial hemorrhage and >8 infusions or >300 mL of volume infusion in the first 8 hours and >10 infusions in the first 24 hours of treatment.

CONCLUSIONS. The number and total volume of intravascular volume administration in the first 8 and 24 hours of venoarterial extracorporeal membrane oxygenation treatment are statistically significantly related to the development of intracranial hemorrhage.

Key Words: extracorporeal membrane oxygenation • intracranial hemorrhage • volume administration

Abbreviations: va-ECMO—venoarterial extracorporeal membrane oxygenation • ICH—intracranial hemorrhage • ACT—activated clotting time • CT—computed tomography • CPR—cardiopulmonary resuscitation • OR—odds ratio • CI—confidence interval

Accepted Nov 19, 2007.