title: The association of carotid artery cannulation and neurologic injury in pediatric patients supported with venoarterial extracorporeal membrane oxygenation*.
abstract: OBJECTIVE
  To describe the prevalence of neurologic injury in a recent cohort of patients 18 years old or younger cannulated for venoarterial extracorporeal membrane oxygenation. To evaluate the association of carotid artery cannulation with neurologic injury when compared with other cannulation sites. To determine if age impacts the association of carotid artery cannulation with neurologic injury.
  
  
  METHODS
  Retrospective analysis of data from the Extracorporeal Life Support Organization registry.
  
  
  METHODS
  Neonatal and pediatric medical/surgical and cardiac ICUs of 118 international tertiary care centers worldwide.
  
  
  METHODS
  Pediatric patients 18 years old or younger cannulated for venoarterial extracorporeal membrane oxygenation and reported to the Extracorporeal Life Support Organization registry during 2007 and 2008.
  
  
  METHODS
  None.
  
  
  RESULTS
  Two thousand nine hundred seventy-seven patients underwent venoarterial extracorporeal membrane oxygenation during the study period. Indications for extracorporeal membrane oxygenation included pulmonary (n = 1,390, 47%), cardiac (n = 1,168, 39%), extracorporeal membrane oxygenation during cardiopulmonary resuscitation (n = 418, 14%), and unknown (n = 1). Arterial cannulation sites were aorta (n = 938, 32%), femoral artery (n = 118, 4%), and carotid artery (n = 1,921, 64%). Overall, 611 patients (21%) had evidence of neurologic injury defined as seizures, infarction, and/or hemorrhage. The occurrence of neurologic injury varied significantly by cannulation site: femoral artery (n = 18, 15%), aorta (n = 160, 17%), and carotid artery (n = 433, 23%); p equals 0.001. Neonates represented the largest group of patients cannulated for venoarterial extracorporeal membrane oxygenation (n = 1,807, 61%), the majority of patients cannulated via the carotid artery (n = 1,276, 66%), and had the highest burden of neurologic injury (n = 398, 22%). Age, preextracorporeal membrane oxygenation high-frequency oscillatory ventilation use, preextracorporeal membrane oxygenation arterial pH and serum bicarbonate level, and preextracorporeal membrane oxygenation cardiac arrest were independently associated with neurologic injury in a covariate model. Carotid artery cannulation site was added to this adjusted model and found to independently increase odds of neurologic injury (odds ratio, 1.4 [95% CI, 1.01-1.69]). An interaction term containing age and cannulation site was not associated with neurologic injury (odds ratio, 1.06 [95% CI, 0.84-1.34]).
  
  
  CONCLUSIONS
  Carotid artery cannulation for venoarterial extracorporeal membrane oxygenation in patients 18 years old or younger is associated with statistically significant increased odds of neurologic injury. These increased odds are present across all age groups.
authors.affiliation: 1Department of Cardiology, Boston Children's Hospital, Boston, MA. 2Department of Pediatrics, Harvard Medical School, Boston, MA. 3Department of Cardiology, Children's Hospital Colorado, Aurora, CO. 4Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO. 5Extracorporeal Life Support Organization (ELSO), University of Michigan, Ann Arbor, MI. 6Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA. 7Department of Surgery, Harvard Medical School, Boston, MA. 8Department of Critical Care Medicine, Hospital for Sick Children, Toronto, ON, Canada. 9Department of Anaesthesia, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Teele
authors.forename: Joshua W
authors.initials: JW
authors.lastname: Salvin
authors.forename: Cindy S
authors.initials: CS
authors.lastname: Barrett
authors.forename: Peter T
authors.initials: PT
authors.lastname: Rycus
authors.forename: Francis
authors.initials: F
authors.lastname: Fynn-Thompson
authors.forename: Peter C
authors.initials: PC
authors.lastname: Laussen
authors.forename: Ravi R
authors.initials: RR
authors.lastname: Thiagarajan
mesh_terms: D000293:Adolescent; D001011:Aorta; D020520:Brain Infarction / Q000453:epidemiology* / Q000209:etiology; D002339:Carotid Arteries; D002404:Catheterization / Q000009:adverse effects* / Q000379:methods; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005263:Femoral Artery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D020300:Intracranial Hemorrhages / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012640:Seizures / Q000453:epidemiology* / Q000209:etiology