The use of cephalad cannulae to monitor jugular venous oxygen content during extracorporeal membrane oxygenation

BACKGROUND: When used during extracorporeal membrane oxygenation (ECMO), jugular venous bulb catheters, known as cephalad cannulae, increase venous drainage, augment circuit flow and decompress cerebral venous pressure. Optimized cerebral oxygen delivery during ECMO may contribute to a reduction in neurological morbidity. This study describes the use of cephalad cannulae and identifies rudimentary data for jugular venous oxygen saturation (JVO(2)) and arterial to jugular venous oxygen saturation difference (AVDO(2)) in this patient population. RESULTS: Patients on venoarterial (VA) ECMO displayed higher JVO(2) (P < 0.01) and lower AVDO(2) (P = 0.01) than patients on venovenous (VV) ECMO (P < 0.01). During VV ECMO, JVO(2) was higher and AVDO(2) lower when systemic pH was < 7.35 rather than > 7.4 (P = 0.01). During VA ECMO, similar differences in AVDO(2) but not in JVO(2) were observed at different pH levels (P = 0.01). CONCLUSIONS: Jugular venous saturation and AVDO(2) were influenced by systemic pH, ECMO type and patient age. These data provide the foundation for normative values of JVO(2) and AVDO(2) in neonates and children treated with ECMO.