Department of Pediatrics and Neurology George Washington University, 2300 I St. NW, Washington, D.C. 20052, USA; Department of Neurology, Children's National Hospital, 111 Michigan Ave. NW, Washington D.C. 20010, USA.
Department of Neurology, Children's National Hospital, 111 Michigan Ave. NW, Washington D.C. 20010, USA.
J Pediatr Surg. 2021 Dec;56(12):2305-2310. doi: 10.1016/j.jpedsurg.2021.01.048. Epub 2021 Feb 4.
In 2008, Children's National Hospital adopted a simple vessel sparing technique (VST) for neck extra corporeal membrane (ECMO) cannulation/decannulation that is technically simple and reproducible. In this study, we review a cohort of patients decannulated from venous-arterial (VA) ECMO using a VST with the goal of understanding flow dynamics and anatomic changes of the common carotid artery (CCA) after repair with a VST.
Patients supported with ECMO at a single, tertiary care center between 2008 and 2019 were identified. Patients were included in the analysis if they survived VA ECMO including VST decannulation and neck vessel imaging was completed with either magnetic resonance angiogram (MRA) or computerized tomography angiogram (CTA) post decannulation. The right CCA was assessed for patency and arteriopathy. Complications and feasibility of repeat ECMO cannulation via the neck vessels were also investigated.
Three hundred and nineteen patients were identified as having received ECMO support in either the PICU or CICU between 2008 and 2019, of which 76 survived VA ECMO support via neck cannulation. Neck vessel imaging was obtained in 21 patients. Ten had imaging demonstrating a normal right CCA. The CCA was occluded in 3 and stenotic in 5. Vessel wall defects were present in 4. No definitive complication was associated with any of the arterial abnormalities. Repeat right CCA cannulation was achieved in 6/7 patients who needed additional VA ECMO support.
Repair of the right CCA with a simple VST can be achieved safely and consistently during VA ECMO support in pediatric patients. Vascular imaging of the right CCA was normal in almost half and repeat cannulation was achieved in most when pursued. Stenosis and vessel wall defects were common, thus neck vessel imaging post decannulation may be warranted for all patients with a right CCA repair after ECMO support.
2008 年，儿童国家医院采用了一种简单的血管保留技术（VST）用于颈部体外膜肺氧合（ECMO）插管/拔管，该技术简单且可重复。在这项研究中，我们回顾了一组使用 VST 进行静脉-动脉（VA）ECMO 拔管的患者，目的是了解修复后颈总动脉（CCA）的血流动力学和解剖学变化 VST。
在 2008 年至 2019 年期间，在一家单一的三级护理中心接受 ECMO 支持的患者被确定。如果患者存活 VA ECMO 支持，包括 VST 拔管，并且在拔管后完成了颈部血管的磁共振血管造影（MRA）或计算机断层血管造影（CTA）检查，则将其纳入分析。评估右 CCA 的通畅性和血管病变。还调查了通过颈部血管重复 ECMO 插管的并发症和可行性。
2008 年至 2019 年间，有 319 名患者在 PICU 或 CICU 接受 ECMO 支持，其中 76 名患者通过颈部插管存活 VA ECMO 支持。21 名患者获得了颈部血管成像。10 名患者的右 CCA 正常。3 例 CCA 闭塞，5 例狭窄。4 例存在血管壁缺损。任何动脉异常均无明确并发症。需要额外 VA ECMO 支持的 6/7 名患者均成功进行了右侧 CCA 再次插管。
在儿科患者的 VA ECMO 支持期间，使用简单的 VST 修复右 CCA 可以安全且一致地进行。血管成像正常的右 CCA 近一半，大多数患者在继续进行时都能成功进行再次插管。狭窄和血管壁缺损很常见，因此，所有接受 ECMO 支持后右 CCA 修复的患者都可能需要进行颈部血管成像。
