Carotid Artery Patency and Neurodevelopmental Outcomes After Decannulation in Pediatric Extracorporeal Life Support
Copyright © 2023 Elsevier Inc. All rights reserved..
INTRODUCTION: Decannulation from veno-arterial extracorporeal life support may involve ligation or repair of the carotid artery; however, differences in outcomes are not clear. This study aimed to describe short- and long-term artery patency and neurodevelopmental outcomes in neonatal and pediatric patients who underwent carotid artery repair (CAR) versus ligation at decannulation.
METHODS: Patients supported on veno-arterial extracorporeal life support during the first 15 mo of life from 2010 to 2020 at a large, tertiary care children's hospital were included. Decannulation strategy, postdecannulation imaging, and follow-up visits were reviewed.
RESULTS: 74 patients were identified with median age at cannulation 2 d (interquartile range [IQR] = 1-21 d) and median weight 3.7 kg (interquartile range= 3.2-4.4 kg). Indications included congenital cardiac conditions (27%), congenital diaphragmatic hernia (19%), pulmonary hypertension (19%), meconium aspiration (16%), and pneumonia/sepsis (14%). Forty-two patients (57%) underwent CAR. Patients on extracorporeal life support >5 d were 95% less likely to undergo CAR (P < 0.001). Of CAR patients, 18 (43%) had doppler ultrasound performed within the 2-y follow-up period. Ten of 18 patients (55.6%) had >50% stenosis (3) or complete occlusion (7). Only 36% (27/74) had formal neurodevelopmental follow-up within 6 mo and 41% (30/74) within 2 y; however, no significant differences in function were seen between groups.
CONCLUSIONS: Neonates and young toddler patients undergoing CAR following extracorporeal life support decannulation are at risk for partial or complete artery occlusion. In our study population, repair and ligation at decannulation appear to have similar neurodevelopmental outcomes; however, follow-up to assess function is not standardized. Longer term follow-up and risk stratification are needed to guide decannulation strategy.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 2023 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:293 |
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| Enthalten in: |
The Journal of surgical research - 293(2023) vom: 01. Jan., Seite 475-481 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Kwon, Eustina G [VerfasserIn] |
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| Links: |
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| Themen: |
Carotid artery |
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| Anmerkungen: |
Date Completed 24.11.2023 Date Revised 24.11.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.jss.2023.09.033 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM363134492 |
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| 100 | 1 | |a Kwon, Eustina G |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Carotid Artery Patency and Neurodevelopmental Outcomes After Decannulation in Pediatric Extracorporeal Life Support |
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| 500 | |a Date Revised 24.11.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 Elsevier Inc. All rights reserved. | ||
| 520 | |a INTRODUCTION: Decannulation from veno-arterial extracorporeal life support may involve ligation or repair of the carotid artery; however, differences in outcomes are not clear. This study aimed to describe short- and long-term artery patency and neurodevelopmental outcomes in neonatal and pediatric patients who underwent carotid artery repair (CAR) versus ligation at decannulation | ||
| 520 | |a METHODS: Patients supported on veno-arterial extracorporeal life support during the first 15 mo of life from 2010 to 2020 at a large, tertiary care children's hospital were included. Decannulation strategy, postdecannulation imaging, and follow-up visits were reviewed | ||
| 520 | |a RESULTS: 74 patients were identified with median age at cannulation 2 d (interquartile range [IQR] = 1-21 d) and median weight 3.7 kg (interquartile range= 3.2-4.4 kg). Indications included congenital cardiac conditions (27%), congenital diaphragmatic hernia (19%), pulmonary hypertension (19%), meconium aspiration (16%), and pneumonia/sepsis (14%). Forty-two patients (57%) underwent CAR. Patients on extracorporeal life support >5 d were 95% less likely to undergo CAR (P < 0.001). Of CAR patients, 18 (43%) had doppler ultrasound performed within the 2-y follow-up period. Ten of 18 patients (55.6%) had >50% stenosis (3) or complete occlusion (7). Only 36% (27/74) had formal neurodevelopmental follow-up within 6 mo and 41% (30/74) within 2 y; however, no significant differences in function were seen between groups | ||
| 520 | |a CONCLUSIONS: Neonates and young toddler patients undergoing CAR following extracorporeal life support decannulation are at risk for partial or complete artery occlusion. In our study population, repair and ligation at decannulation appear to have similar neurodevelopmental outcomes; however, follow-up to assess function is not standardized. Longer term follow-up and risk stratification are needed to guide decannulation strategy | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Carotid artery | |
| 650 | 4 | |a ECLS | |
| 650 | 4 | |a ECMO | |
| 650 | 4 | |a Neurodevelopment | |
| 650 | 4 | |a Pediatrics | |
| 650 | 4 | |a Vascular surgery | |
| 700 | 1 | |a Anderson, Jamie E |e verfasserin |4 aut | |
| 700 | 1 | |a DiGeronimo, Robert |e verfasserin |4 aut | |
| 700 | 1 | |a Kirk, Christa C J |e verfasserin |4 aut | |
| 700 | 1 | |a Billimoria, Zeenia C |e verfasserin |4 aut | |
| 700 | 1 | |a Rothstein, David H |e verfasserin |4 aut | |
| 700 | 1 | |a Stark, Rebecca |e verfasserin |4 aut | |
| 700 | 1 | |a McMullan, D Michael |e verfasserin |4 aut | |
| 700 | 1 | |a Brogan, Thomas V |e verfasserin |4 aut | |
| 700 | 1 | |a Riehle, Kimberly J |e verfasserin |4 aut | |
| 700 | 1 | |a Rice-Townsend, Samuel E |e verfasserin |4 aut | |
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