Five-year follow-up of neonates with reconstructed right common carotid arteries after extracorporeal membrane oxygenation

Desai, Shobhana; Stanley, Christian; Gringlas, Marcy; Merton, Daniel A.; Wolfson, Philip J.; Needleman, Laurence; Graziani, Leonard J.; Baumgart, Stephen

doi:10.1016/s0022-3476(99)70199-x

Cited by 55 publications

(32 citation statements)

References 20 publications

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“…When examining their own neonatal ECMO population who all underwent ligation, Schumacher et al found an increased incidence of right-sided brain lesions on imaging as well as abnormal neuromotor findings on the left [5]. Other studies have noted questionable lateralizing signs and variable imaging studies after ligation as well [15,16,18]. In our study and experience, we observed a high frequency of severe brain lesions in all neonates placed on VA-ECMO, regardless of the status of the carotid artery after decannulation.…”

Section: Discussionmentioning

confidence: 99%

“…However, studies examining the patency of the artery over time have had mixed results. Desai et al looked at patients after repair and found little or no change in the patency of the carotid artery from their status at discharge for the majority of patients [18]. Other studies have shown patency, but evidence of increased stenosis in the repaired carotid arteries several months to years after repair [24–26].…”

Section: Discussionmentioning

confidence: 99%

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Neonatal carotid repair at ECMO decannulation: patency rates and early neurologic outcomes

Duggan

Maitre

Zhai

et al. 2015

Journal of Pediatric Surgery

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Purpose Neonates placed on veno-arterial extracorporeal membrane oxygenation (VA-ECMO) undergo either carotid repair or ligation at decannulation. Study aims were to evaluate carotid patency rates after repair and to compare early neurologic outcomes between repaired and ligated patients. Methods A retrospective study of all neonates without congenital heart disease (CHD) who had VA-ECMO between 1989 and 2012 was completed using our institutional ECMO Registry. Carotid patency after repair, neuroimaging studies, and auditory brainstem response (ABR) testing at time of discharge were examined. Results 140 neonates were placed on VA-ECMO during the study period. Among survivors, 84% of carotids repaired and imaged remained patent at last study. No significant differences were observed between infants in the repaired and ligated groups regarding diagnosis, ECMO duration, or length of stay. A large proportion (43%) developed a severe brain lesion after VA-ECMO, but few failed their ABR testing. Differences in early neurologic outcomes between the two groups of survivors were not significant. Conclusions At this single institution, carotid patency is excellent following repair at ECMO decannulation. No increased incidence of severe brain lesions or greater neurosensory impairment in the repair group was observed. Further studies are needed to investigate the effects of ligation on longer-term neurocognitive outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Neonatal carotid repair at ECMO decannulation: patency rates and early neurologic outcomes

Duggan

Maitre

Zhai

et al. 2015

Journal of Pediatric Surgery

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“…The incidence of cerebral ischemic lesions associated with lateralized neuromotor dysfunction and abnormal electroencephalography is significantly increased in the side ipsilateral to VA ECMO cannulation (5)(6)(7). Reconstruction of CA following VA ECMO results in a long-term patency of the CA in 76 -93% of patients and may decrease the incidence of brainscan abnormalities and cerebral palsy (8,9). However, the lack of data on direct causality of CA-ligation in cerebral complications of VA ECMO makes the rationale for routine reconstruction of CA controversial.…”

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confidence: 99%

Systemic Hyperthermia Induces Ischemic Brain Injury in Neonatal Mice With Ligated Carotid Artery and Jugular Vein

et al. 2007

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Postnatal d 7 (p7) or p12 mice had their right carotid artery (CA) and jugular vein (JV) ligated to mimic veno-arterial (VA) access for extracorporeal membrane oxygenation (ECMO). At p9 -11 (early) or p19 -21 (late) mice were exposed to hyperthermia or normothermia followed by assessment of neuropathological injury score. In separate cohorts of mice, cerebral and peripheral blood flow (CBF, PBF) and cerebral ATP content was measured. Hyperthermia resulted in ischemic brain injury in 57% and 77% of mice subjected to early or late hyperthermia, respectively. Isolated CAϩJV ligation induced minimal injury (score 0.47 Ϯ 0.34) in 2/8 mice from the late normothermia group. No cerebral injury was detected in mice subjected to early normothermia. In 3/19 shams (2/10 early, 1/9 late) hyperthermia induced a subtle (score, 0.6 Ϯ 0.27) injury in the ipsilateral to the site of surgery cortex. CBF and PBF increased in response to hyperthermia in all mice. The rise in CBF was significantly attenuated in the "ligated" versus intact hemisphere, which was associated with a profound depletion of ATP content. Systemic hyperthermia induces ischemic brain injury in mice with ligated CAϩJV. We speculate that hyperthermia/fever can be a potential risk factor for brain injury in infants treated with VA ECMO.

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“…Sometimes the common carotid artery is selected to 8 if we fi nd a narrow femoral artery, we consistently use the ascending aorta for infl ow and the right atrium for outfl ow to maintain suffi cient blood fl ow, which has resulted in a favorable prognosis with no complications. Reiss et al studied seven cases of fulminant myocarditis treated with VAD (as LVAD in three and BiVAD in four) in children and young people (mean age 13.5 years old) and reported that four were successfully maintained as a bridge to heart transplantation, one was weaned, and one was still on support with assisted circulation.…”

Section: Discussionmentioning

confidence: 99%

Mechanical circulatory support for fulminant myocarditis

et al. 2008

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Five-year follow-up of neonates with reconstructed right common carotid arteries after extracorporeal membrane oxygenation

Cited by 55 publications

References 20 publications

Neonatal carotid repair at ECMO decannulation: patency rates and early neurologic outcomes

Neonatal carotid repair at ECMO decannulation: patency rates and early neurologic outcomes

Systemic Hyperthermia Induces Ischemic Brain Injury in Neonatal Mice With Ligated Carotid Artery and Jugular Vein

Mechanical circulatory support for fulminant myocarditis

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