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Carotid artery repair after pediatric extracorporeal membrane oxygenation
V Adolph1, S Bonis, K Falterman
1Department of Surgery, Louisiana State University School of Medicine, New Orleans.
Insights
Extracorporeal membrane oxygenation (ECMO) can improve survival in pediatric patients. Reconstructing the common carotid artery after ECMO is feasible and carries a low risk of embolic complications, aiding recovery.
Area of Science:
- Pediatric Cardiology
- Cardiopulmonary Support
- Vascular Surgery
Background:
- Extracorporeal membrane oxygenation (ECMO) offers improved survival for neonates and is increasingly used for pediatric respiratory and cardiac failure.
- A significant concern with ECMO is the ligation of the right common carotid artery.
Purpose of the Study:
- To evaluate the safety and feasibility of reconstructing the common carotid artery after ECMO in pediatric patients.
- To assess the risk of embolic complications following carotid artery repair post-ECMO.
Main Methods:
- Retrospective analysis of 32 pediatric patients (10 cardiac, 22 respiratory failure) supported with ECMO via right common carotid artery and internal jugular vein cannulation.
- Surgical reconstruction of the common carotid artery in survivors at decannulation.
- Post-operative assessment including color Doppler studies and cranial CT scans.
Main Results:
- 31 patients were cannulated via the right common carotid artery.
- Four of the last six respiratory failure survivors underwent successful common carotid artery reconstruction.
- Post-repair Doppler studies and cranial CT scans were normal, with no clinical evidence of emboli.
Conclusions:
- Common carotid artery reconstruction following ECMO in pediatric patients can be performed with a low risk of embolic complications.
- This procedure appears safe and feasible, potentially improving outcomes for pediatric ECMO patients.
- Long-term follow-up is recommended to fully ascertain the long-term benefits and risks.
Abstract:
Extracorporeal membrane oxygenation (ECMO), which has been shown to dramatically improve survival in selected neonatal patients, is now being used in some centers for pediatric patients with respiratory and cardiac failure. One of the major concerns with ECMO support is the permanent ligation of the right common carotid artery. We have used ECMO to support 10 pediatric patients with cardiac failure and 22 patients with respiratory failure. Thirty-one were cannulated via the common carotid artery and internal jugular vein on the right. Five of the last six patients with respiratory failure survived. One was on ECMO for 21 days, so the carotid artery was not amenable to repair. In the other four survivors the common carotid artery was reconstructed at the time of decannulation. In one patient, a segment of the artery was resected because of an intimal injury, and a primary anastomosis was performed. In all four, color Doppler studies of the artery prior to discharge were normal. None had clinical evidence of emboli, and a cranial computed tomography (CT) scan was normal in all four patients. These data suggest that in many pediatric patients supported with ECMO, reconstruction of the common carotid artery can be performed with low risk of embolic complications. Long-term follow-up is needed.