L. A. Gil1,3, J. C. Apfeld1,3, A. B. Walczak5, W. J. Frazier4, R. B. Seabrook4, O. O. Olutoye1,3, P. C. Minneci1,3 1Center for Surgical Outcomes Research, Nationwide Children’s Hospital, Columbus, OH, USA 3Nationwide Children’s Hospital, Department Of Pediatric Surgery, Columbus, OH, USA 4Nationwide Children’s Hospital, Department Of Pediatrics, Columbus, OH, USA 5Nationwide Children’s Hospital, The Heart Center, Columbus, OH, USA
Introduction: In the pediatric and neonatal populations, the carotid artery is commonly cannulated for veno-arterial (VA) ECMO, and the decision to ligate (CAL) versus reconstruct (CAR) the artery at decannulation remains controversial. This study aims to summarize the current literature on clinical outcomes following CAL and CAR after VA-ECMO
Methods: PubMed (MEDLINE), Embase, Web of Science, and Cochrane databases were searched using different keywords from January 1950 to October 2020. Studies examining clinical outcomes following CAL and CAR during VA-ECMO decannulation in neonates and children <18 years of age were included. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed and performed independently by two reviewers. Assessment of risk of bias was performed.
Results: 80 included studies were classified into 4 categories: non-comparative clinical outcomes after CAL (n=23, 28.8%), non-comparative clinical outcomes after CAR (n=12, 15.0%), comparative clinical outcomes after CAL and/or CAR (n=28, 35.0%), and case reports of clinical outcomes after CAL and/or CAR (n=17, 21.3%). Follow-up time ranged from 0 to 11 years. There was no substantial evidence that supported a direct association between CAL versus CAR and short-term neurologic outcomes. CAR patency rates in non-comparative studies ranged from 44-100%.
Conclusion: The available literature on outcomes after CAL versus CAR following decannulation after VA-ECMO is heterogeneous with limited generalizability. Further studies are needed to identify subpopulations of patients who may be potential beneficiaries of CAR and to evaluate the long-term consequences of CAL versus CAR.
