Follow-Up Brain MRI After Carotid Reconstruction or Ligation in Neonatal Venoarterial Extracorporeal Membrane Oxygenation: Single-Center Retrospective Cohort, 2009-2022.

OBJECTIVES

In neonates, the carotid artery can be ligated or reconstructed at the time of decannulation from venoarterial extracorporeal membrane oxygenation (VA-ECMO). However, there is a paucity of data on the neurologic outcomes of one approach vs. the other. We therefore aimed to compare the brain MRI of VA-ECMO patients who had either undergone carotid reconstruction or ligation at the time of decannulation in our NICU.

DESIGN

Single-center retrospective study.

SETTING

Tertiary-level neonatal care, that is, level IV NICU.

PATIENTS: Neonates younger than 28 days old who survived to VA-ECMO decannulation and underwent routine post-decannulation brain MRI between June 2009 and September 2022.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN

RESULTS

Eighty-one patients were included in this study: 38 of 81 (47%) with carotid reconstruction and 43 of 81 (53%) who underwent carotid ligation. We failed to identify associations between decannulation strategy and demographics, ECMO indication, cannulation duration, head ultrasound abnormalities during ECMO, and survival to hospital discharge. Overall, 54 of 81 patients (67%) displayed at least one abnormality on post-decannulation brain MRI. We failed to identify an association between decannulation strategy and focal ischemic lesions, MRI injury score, and proportion with intraventricular hemorrhage. However, there was an association between strategy and grade 2-4 IVH (reconstruction vs. ligation: 10 of 38 vs. 3 of 43; mean difference 19.3% [95% CI, 3.1-35.6%], p = 0.02).

CONCLUSIONS

In our neonatal VA-ECMO series from 2009 to 2022, follow-up brain MRI shows a high frequency of abnormalities or lesions. Overall, we failed to identify an association between decannulation strategy (i.e., carotid ligation or reconstruction) and proportion with ischemic findings. However, there appears to be an association between carotid reconstruction and higher-grade IVH. Further studies are needed to help with decision-making at the time of decannulation, to discern the mechanisms underlying the radiographic differences we identified in our series, and to investigate the connection between structural changes and long-term neurocognitive outcomes.