Abstract
Although ligation of the carotid artery following extracorporeal membrane oxygenation (ECMO) procedures has not been associated with any apparent acute neurologic changes, its long-term sequelae on cerebral function are still unknown. The authors have adopted a policy of repairing all carotid arteries following ECMO. Between April 1990 and June 1993, 34 consecutive patients underwent carotid artery reconstruction. Indications for ECMO were respiratory distress syndrome in 18, meconium aspiration in 8, pneumonia in 6, myocardial failure in 1, and sickle cell anemia in 1. All patients were neonates (ages seventy-two ± sixty-three hours), except 5 (2, three months; 1, two years; and 2, four years old).
Duration of ECMO was (mean ± SD, 156 ± 68 hours). Arterial cannulation was performed after extended mobilization of the carotid artery by using a Biomedicus (8- 10F) cannula. Following decannulation the traumatized segment was resected and the artery repaired by means of multiple interrupted nonabsorbable 7-0 sutures. No heparin was given. There were no complications related to repair.
Follow-up is available on all patients (7.6 ±4.1 months). Detailed neurologic evalu ation and ultrasound and Doppler studies of the carotid artery were performed on all patients at discharge, at two months, at six months, and at one year following ECMO. All carotid arteries were patent with good flow, except one. Transient communicating hydro cephalus developed in 1 patient but responded readily to medical treatment. The rest have normal-for-age neurologic evaluation. The authors' experience suggests that carotid reconstruction following ECMO is feasible, safe, and probably advantageous in the long term. Further follow-up is necessary before this technique can be applied to all infants undergoing ECMO procedure.
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