Seattle Children's Hospital, University of Washington, Seattle, Washington.
Seattle Children's Hospital, University of Washington, Seattle, Washington.
J Surg Res. 2024 Jan;293:475-481. doi: 10.1016/j.jss.2023.09.033. Epub 2023 Oct 10.
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.
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.
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.
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.
从静脉-动脉体外生命支持中拔管可能涉及颈动脉结扎或修复; 然而，结果的差异尚不清楚。本研究旨在描述新生儿和儿科患者在拔管时行颈动脉修复 (CAR) 与结扎后短期和长期动脉通畅性和神经发育结局。
纳入 2010 年至 2020 年期间在一家大型三级儿童医院接受静脉-动脉体外生命支持治疗的前 15 个月内出生的患者。回顾拔管策略、拔管后影像学检查和随访情况。
共确定 74 例患者，中位置管年龄为 2 天 (四分位距 [IQR] = 1-21 天)，中位体重为 3.7kg (IQR = 3.2-4.4kg)。适应证包括先天性心脏疾病 (27%)、先天性膈疝 (19%)、肺动脉高压 (19%)、胎粪吸入 (16%)和肺炎/败血症 (14%)。42 例患者 (57%)行 CAR。体外生命支持时间>5 天的患者行 CAR 的可能性低 95% (P<0.001)。CAR 患者中，18 例 (43%)在 2 年随访期间行多普勒超声检查。18 例患者中有 10 例 (55.6%)存在>50%狭窄 (3 例)或完全闭塞 (7 例)。仅 36% (74 例中有 27 例)在 6 个月内和 41% (74 例中有 30 例)在 2 年内进行了正式的神经发育随访; 然而，两组之间的功能没有显著差异。
行体外生命支持拔管后行 CAR 的新生儿和幼儿患者存在部分或完全动脉闭塞的风险。在我们的研究人群中，拔管时行修复和结扎似乎具有相似的神经发育结局; 然而，随访以评估功能并未标准化。需要进行长期随访和风险分层以指导拔管策略。
