Background:
ECMO is a critical intervention for neonatal patients with severe respiratory failure unresponsive to conventional therapy. Veno-arterial ECMO requires cannulation of major cervical vessels, raising concerns about potential long-term vascular and neurological sequelae.
Objective:
To assess the long-term outcomes of internal jugular vein and common carotid artery cannulation in neonates treated with veno-arterial ECMO, with a focus on vascular patency, cerebral perfusion, and neurodevelopmental status following surgical reconstruction during decannulation.
Methods:
A retrospective cohort study was conducted at the Filatov Children's City Clinical Hospital (Moscow) from 2016 to 2024, including 66 neonates (mean age: 4.76 ± 4.83 days; mean weight: 3490.7 ± 567.36 g) who underwent right-sided vascular cannulation for ECMO. The mean ECMO duration was 8.95 ± 7.3 days. Surgical reconstruction of cannulated vessels was performed in 61.4% of cases during decannulation, while partial or complete ligation was performed in the remainder. Twenty patients with vascular reconstruction were enrolled in long-term follow-up, which included Doppler ultrasonography, brain MRI, fundus examination, and neurologic evaluation.
Results:
All reconstructed vessels remained patent on DUS, although asymmetry in vessel diameter and flow velocity was observed. No critical flow impairment was identified. Brain MRI findings indicated post-hypoxic lesions in the majority, with no evidence of perfusion-related focal injury attributable to cannulation. Fundus examinations revealed no ipsilateral retinal pathology; mild retinal angiopathy was observed in some cases, without consistent lateralization. Neurological assessments showed age-appropriate development in most patients, with isolated cases of cerebroasthenic syndrome, delayed development, and hemiparesis secondary to intracerebral hemorrhage.
Conclusion:
Surgical cannulation and subsequent reconstruction of the internal jugular vein and common carotid artery in neonates undergoing ECMO is not associated with focal cerebral perfusion deficits, ophthalmic abnormalities, or long-term focal neurological impairments. Observed neurological and imaging abnormalities were primarily attributed to underlying disease and hypoxic injury rather than vascular access.
Keywords: Ecmo, cannulation, decanulation, neonates, vascular reconstruction
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