Increased carotid artery intima-media thickness following venoarterial extracorporeal membrane oxygenation in the neonatal period

Abstract

Objective: To compare left carotid intima-media thickness (CIMT) and biochemical markers for atherogenesis in neonatal venoarterial extracorporeal membrane oxygenation (ECMO) survivors with normal controls during childhood.Methods: Venoarterial ECMO survivors and healthy patients between 12 and 18 years of age were enrolled in a matched control prospective study. ECMO survivors were matched to controls based on chronological age and percentage of body mass index (BMI). Measured CIMT of the posterior left carotid artery and CIMT values corrected for carotid artery size were used for data analysis.Results: Thirty-one neonatal venoarterial ECMO survivors were matched to 31 healthy controls. No significant differences were found between ECMO survivors and controls for age, weight, percentage of BMI, total fat composition, lipid profiles, ultrasensitive C-reactive protein or homocysteine levels. Significant differences between ECMO and controls patients were found in systolic, diastolic and mean left CIMT. IntroductionExtracorporeal membrane oxygenation (ECMO) is used to treat severe cardiorespiratory failure refractory to conventional medical management. In newborns, ECMO is most commonly used to treat respiratory failure caused by meconium aspiration syndrome, congenital diaphragmatic hernia, sepsis/pneumonia and persistent pulmonary hypertension. Since the inception of ECMO support, the Extracorporeal Life Support Organization (ELSO) registry has documented over 14 000 late preterm and term neonates treated with venoarterial ECMO for respiratory indications, resulting in an overall survival of 73%1 The most common approach to providing ECMO support in neonates is achieved by cannulation of the right common carotid artery (RCCA) and the right internal jugular vein. Most ECMO centers ligate the RCCA at the time of ECMO decannulation. Although no adverse effects are clinically apparent following ECMO support and ligation of the RCCA, these children are dependent on only three arteries (the vertebral arteries and the left carotid artery) to maintain adequate cerebral perfusion. As many of these former neonatal venoarterial ECMO survivors are reaching young adulthood, we set out to investigate whether neonatal ECMO survivors are at an increased risk for premature atherosclerosis and cardiovascular disease (CVD). In adults and older children, carotid artery intima-media thickness (CIMT) is an accepted marker for CVD risks.2 Indeed, in adult populations, when elevated, CIMT is associated with an increased risk for peripheral arterial disease, stroke and coronary events.

Outcome analysis of neonates with congenital diaphragmatic hernia treated with venovenous vs venoarterial extracorporeal membrane oxygenation

“…It is conceivable that these patients may be more prone to adult carotid artery disease because of atherosclerosis within smaller collaterals or lesions along the intact left carotid artery. According to a recent report, carotid artery intima-media thickness is increased in the left carotid artery in VA-ECMO survivors compared with matched controls at 12 to 18 years of age [34]. However, it is unknown whether increased carotid artery intima-media thickness will increase the risk of long-term cerebrovascular disease.…”