The effect of common origin of the carotid arteries in neurologic outcome after neonatal ECMO.
BACKGROUND
Common origin of the carotid arteries (COCA) is a normal anatomic variant reported to occur in approximately 11% of the general population. The objective of this study was to determine whether this variant places venoarterial extracorporeal membrane oxygenation (ECMO) patients at a higher risk for adverse neurologic sequelae owing to potential occlusion of both carotid arteries by the arterial cannula.


METHODS
The authors reviewed clinical records and echocardiograms of the initial 220 ECMO patients at their institution. Aortic arch morphology was determined by a pediatric cardiologist blinded to all other data. After exclusion of predetermined patients, 131 patients were divided into 2 groups: those with separate origin of the carotid arteries (n = 111) and those with COCA (n = 20). The neurologic outcome variables studied included the results of magnetic resonance imaging (MRI); computed tomography (CT); electroencephalogram (EEG); brainstem auditory-evoked response (BAER), head ultrasound scan, and Bayley Scales of Infant Development reported as Psychomotor Developmental Index (PDI) and Mental Developmental Index (MDI).


RESULTS
COCA had no predictive value in determining PDI and MDI outcomes and no significance in predicting an increased risk of adverse neurologic sequelae based on MRI, CT, EEG, BAER, or head ultrasound scan.


CONCLUSIONS
This study confirms that COCA is a common aortic arch variant (15%, n = 20 of 131) and that this variant does not appear to increase the risk of neurologic injury in infants undergoing venoarterial ECMO.
Lamers
Luke J
LJ
Department of Pediatrics, The Ohio State University, Children's Hospital, Columbus, OH 43205, USA.
Rowland
Daniel G
DG
Seguin
John H
JH
Rosenberg
Ellen M
EM
Reber
Kristina M
KM
D016122:Brachiocephalic Trunk / Q000033:anatomy & histology*; D001925:Brain Damage, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D002339:Carotid Arteries / Q000033:anatomy & histology*; D002404:Catheterization / Q000009:adverse effects*; D004569:Electroencephalography; D016057:Evoked Potentials, Auditory, Brain Stem; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects* / Q000295:instrumentation; D014644:Genetic Variation; D006801:Humans; D002534:Hypoxia, Brain / Q000453:epidemiology / Q000209:etiology*; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D011596:Psychomotor Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D012131:Respiratory Insufficiency / Q000628:therapy*; D012189:Retrospective Studies; D012306:Risk; D016037:Single-Blind Method; D014057:Tomography, X-Ray Computed