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Published on: February 17, 2013
Cerebral Infarction During Cervical Veno-Arterial Extracorporeal Membrane Oxygenation in Children: Can it be
Aditya Patukale1,2,3, Jennifer Powell2,4, Supreet Marathe1,2,3
1Queensland Paediatric Cardiac Service, 67568Queensland Children's Hospital, Brisbane, Australia.
Insights
Cerebral infarction in children undergoing VA ECMO may occur due to an incomplete circle of Willis. This study highlights 3 cases of cervical cannulation-related cerebral infarction potentially linked to this anatomical variation.
Area of Science:
- Pediatric Cardiology
- Neurology
- Cardiovascular Surgery
Background:
- Veno-arterial extracorporeal membrane oxygenation (VA ECMO) is a critical support for critically ill children.
- Cervical cannulation, using the right carotid artery and right internal jugular vein, is a common VA ECMO approach in pediatrics.
- Cerebral infarction is a recognized complication in pediatric VA ECMO patients.
Purpose of the Study:
- To investigate the potential link between incomplete Circle of Willis anatomy and cerebral infarction in pediatric patients undergoing VA ECMO with cervical cannulation.
- To present clinical cases illustrating this association.
Main Methods:
- Retrospective review of 3 pediatric cases undergoing VA ECMO with cervical cannulation.
- Analysis of neurological outcomes, focusing on cerebral infarction.
- Consideration of Circle of Willis patency in relation to observed complications.
Main Results:
- Three pediatric patients developed cerebral infarction during VA ECMO with cervical cannulation.
- The cerebral infarction in these cases is hypothesized to be associated with an incomplete Circle of Willis.
- This anatomical variation may compromise cerebral perfusion during VA ECMO.
Conclusions:
- An incomplete Circle of Willis may be a predisposing factor for cerebral infarction in pediatric patients receiving VA ECMO via cervical cannulation.
- Further investigation into pre-procedural anatomical assessment is warranted.
- Understanding this association can inform strategies to mitigate neurological injury.
Abstract:
Veno-arterial extra-corporeal membrane oxygenation (VA ECMO) in children is often established by cannulation of the right carotid artery and the right internal jugular vein. Cerebral infarction which is sometimes seen in such cases may be secondary to an incomplete circle of Willis. We present 3 cases with VA ECMO using cervical cannulation who suffered cerebral infarction which may be attributed to an incomplete circle of Willis.
