Right common carotid artery ligation in extracorporeal membrane oxygenation

Campbell, Lynn; Bunyapen, Chantrapa; Holmes, Gregory L.; Howell, Charles G.; Kanto, William P.

doi:10.1016/s0022-3476(88)80543-2

Cited by 85 publications

(32 citation statements)

References 13 publications

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“…Some authors describe predominance of cerebral lesions in especially the right hemisphere of the brain, while in other studies this predominance, possibly related to ligation of the right common carotid artery and right internal jugular vein, could not be confirmed [50,51,52,53,54,55,56]. It has to be stressed that all studies mentioned concern neonates treated with va-ECMO.…”

Section: Cerebral Aspects Related To Neonatal Ecmomentioning

confidence: 99%

Cerebral Aspects of Neonatal Extracorporeal Membrane Oxygenation: A Review

2013

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Background: Neonatal extracorporeal membrane oxygenation (ECMO) is a lifesaving therapeutic approach in newborns suffering from severe, but potentially reversible, respiratory insufficiency, mostly complicated by neonatal persistent pulmonary hypertension. However, cerebral damage, intracerebral hemorrhage as well as ischemia belong to the most devastating complications of ECMO. Objectives: The objectives are to give insights into what is known from the literature concerning cerebral damage related to neonatal ECMO treatment for pulmonary reasons. Methods: A short introduction to ECMO indications and technical aspects of ECMO are provided for a better understanding of the process. The remainder of this review focuses on outcome and especially on (potential) risk factors for cerebral hemorrhage and ischemia during ECMO treatment. Results: Although neonatal ECMO treatment shows improved outcome compared to conservative treatment in cases of severe respiratory insufficiency, it is related to disturbances in various aspects of neurodevelopmental outcome. Risk factors for cerebral damage are either related to the patient's disease, EMCO treatment itself, or a combination of both. Conclusion: It is of ongoing importance to further understand pathophysiological mechanisms resulting in cerebral hemorrhage and ischemia due to ECMO and to develop neuroprotective strategies and approaches.

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Section: Cerebral Aspects Related To Neonatal Ecmomentioning

confidence: 99%

Cerebral Aspects of Neonatal Extracorporeal Membrane Oxygenation: A Review

2013

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“…In ECMOtreated neonates, CA-ligation, but not JV-ligation, resulted in a significant decrease in oxyhemoglobin concentration (and rise in the deoxyhemoglobin level) in the brain (4). 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).…”

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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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“…Besides the magnitude, changes in HbD and CBV occur very acute, which might be an additional risk factor for cerebral lesions by itself. Some authors describe predominance of cerebral lesions in especially the right hemisphere of the brain, whereas in other studies, this predominance, possibly related to ligation of the right carotic artery and right internal jugular vein, could not be confirmed (37)(38)(39)(40)(41)(42)(43). To study differences between both hemispheres, we used two receiving NIRS optodes.…”

Section: Discussionmentioning

confidence: 96%

Effect of Bladderbox Alarms During Venoarterial Extracorporeal Membrane Oxygenation on Cerebral Oxygenation and Hemodynamics in Lambs

et al. 2009

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ABSTRACT:To determine the effects of bladderbox alarms during venoarterial extracorporeal membrane oxygenation (va-ECMO) on cerebral oxygenation and hemodynamics, six lambs were prospectively treated with va-ECMO and bladderbox alarms were simulated. Changes in concentrations of oxyhemoglobin (⌬cO 2 Hb), deoxyhemoglobin (⌬cHHb), and total Hb (⌬ctHb) were measured using near infrared spectrophotometry. Fluctuations in Hb oxygenation index (⌬HbD) and cerebral blood volume (⌬CBV) were calculated. Heart rate (HR), mean arterial pressure (MAP), blood flow in the left carotid artery (Qcar), and central venous pressure (CVP) were registered. Bladderbox alarms were simulated by increasing the ECMO flow or partially clamping the venous cannula and resolved by decreasing the ECMO flow, unclamping the cannula, or intravascular volume administration. CBV, HbD, MAP, and Qcar decreased significantly during bladderbox alarms, whereas HR and CVP increased. After the bladderbox alarms, CBV and HbD increased significantly to values above baseline. For HbD, this increase was higher during intravascular volume administration. MAP, Qcar, and CVP recovered to preexperiment values but increased further with volume administration. HR was increased at the end of our measurements. We conclude that Bladderbox alarms during va-ECMO treatment result in significant fluctuations in cerebral oxygenation and hemodynamics, a possible risk factor for intracranial lesions. (Pediatr Res 66: 688-692, 2009) E xtracorporeal membrane oxygenation (ECMO) has become a rescue therapy for neonates with severe, but potentially reversible, respiratory failure when maximal conventional therapy has failed. Without ECMO, there is a high mortality rate (1,2). Since the first newborn was successfully treated with venoarterial extracorporeal membrane oxygenation (va-ECMO) by Bartlett et al. in 1976 (3), more than 22,000 neonates have been treated with ECMO, of which 15,000 with va-ECMO, with an overall survival rate of 80% (4). Although ECMO has increased survival, the occurrence of hemorrhagic and ischemic cerebral lesions resulting in future neurologic and neurodevelopmental dysfunction are of major concern (5,6). Imaging studies revealed hemorrhagic or ischemic intracranial abnormalities in 10 up to even 52% of the patients (7-9). These complications justify a continuous search for factors related to intracranial hemorrhage and ischemia and treatment strategies aimed to improve outcome.Part of the va-ECMO system is a bladderbox, which is situated between the venous cannula and the rollerpump of the extracorporeal system. The bladderbox controls venous drainage of blood from the right atrium of the patient. If the venous drainage becomes inadequate to maintain the established flow of the ECMO system, the bladderbox will give an alarm, slow down the pump, and finally cause an acute interruption of the rollerpump resulting in interruption of blood flow to the patient. If other causes of inadequate venous drainage from the right atrium and consecutive bladderbox ala...

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Right common carotid artery ligation in extracorporeal membrane oxygenation

Cited by 85 publications

References 13 publications

Cerebral Aspects of Neonatal Extracorporeal Membrane Oxygenation: A Review

Cerebral Aspects of Neonatal Extracorporeal Membrane Oxygenation: A Review

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

Effect of Bladderbox Alarms During Venoarterial Extracorporeal Membrane Oxygenation on Cerebral Oxygenation and Hemodynamics in Lambs

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