title: Neonatal carotid repair at ECMO decannulation: patency rates and early neurologic outcomes.
abstract: OBJECTIVE
  Neonates placed on veno-arterial extracorporeal membrane oxygenation (VA-ECMO) undergo either carotid repair or ligation at decannulation. Study aims were to evaluate carotid patency rates after repair and to compare early neurologic outcomes between repaired and ligated patients.
  
  
  METHODS
  A retrospective study of all neonates without congenital heart disease (CHD) who had VA-ECMO between 1989 and 2012 was completed using our institutional ECMO Registry. Carotid patency after repair, neuroimaging studies, and auditory brainstem response (ABR) testing at time of discharge were examined.
  
  
  RESULTS
  140 neonates were placed on VA-ECMO during the study period. Among survivors, 84% of carotids repaired and imaged remained patent at last study. No significant differences were observed between infants in the repaired and ligated groups regarding diagnosis, ECMO duration, or length of stay. A large proportion (43%) developed a severe brain lesion after VA-ECMO, but few failed their ABR testing. Differences in early neurologic outcomes between the two groups of survivors were not significant.
  
  
  CONCLUSIONS
  At this single institution, carotid patency is excellent following repair at ECMO decannulation. No increased incidence of severe brain lesions or greater neurosensory impairment in the repair group was observed. Further studies are needed to investigate the effects of ligation on longer-term neurocognitive outcomes.
authors.affiliation: Department of Pediatric Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center. Electronic address: Eileen.m.duggan@vanderbilt.edu.
authors.forename: Eileen M
authors.initials: EM
authors.lastname: Duggan
authors.affiliation: Department of Pediatrics, Division of Neonatology, Vanderbilt University Medical Center.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Maitre
authors.affiliation: Department of Pediatric Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center.
authors.forename: Amy
authors.initials: A
authors.lastname: Zhai
authors.affiliation: Department of Pediatric Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center.
authors.forename: Harish
authors.initials: H
authors.lastname: Krishnamoorthi
authors.affiliation: Department of Pediatric Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center.
authors.forename: Igor
authors.initials: I
authors.lastname: Voskresensky
authors.affiliation: Department of Pediatric Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center.
authors.forename: Daphne
authors.initials: D
authors.lastname: Hardison
authors.affiliation: Department of Pediatric Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center.
authors.forename: Jamie
authors.initials: J
authors.lastname: Tice
authors.affiliation: Department of Pediatric Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center.
authors.forename: John B
authors.initials: JB
authors.lastname: Pietsch
authors.affiliation: Department of Pediatric Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center.
authors.forename: Harold N
authors.initials: HN
authors.lastname: Lovvorn
mesh_terms: D001921:Brain; D002339:Carotid Arteries / Q000601:surgery; D016057:Evoked Potentials, Auditory, Brain Stem; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D008026:Ligation; D008297:Male; D011184:Postoperative Period; D012189:Retrospective Studies; D014654:Vascular Patency
keywords: Auditory brainstem response; Carotid artery repair; ECMO; Neurologic outcomes