• Tiffany Zens, R Scott Eldredge, Manrit Gill, Steven Mathew, and Mark Molitor.
• Division of Pediatric Surgery, Department of Surgery, Phoenix Children's Hospital, Phoenix, AZ.
• Pediatr Crit Care Me. 2023 Dec 1; 24 (12): 107210831072-1083.

ObjectivesExtracorporeal membrane oxygenation (ECMO) is an invaluable life-support resource in the treatment of critically ill children. Traditionally, neck vascular cannulation requires ligation of the carotid artery and jugular vein. In this literature review, we identify rates of postoperative vessel patency, complications, and neurologic outcomes after vascular reconstruction following decannulation.Data SourcesEmbase, PubMed, and Cochrane Review.Study SelectionNo publication date limits. Inclusion criteria comprised of studies addressing repair of the carotid artery and jugular vein after ECMO decannulation and outcomes from this procedure.Data ExtractionAuthors identified publications on vascular reconstruction after ECMO decannulation, including possible technical considerations, complications, and outcomes.Data SynthesisWe identified 18 articles: 13 studies were limited to the neonatal population. The largest series included 51 patients after vascular reconstruction. The rate of postoperative arterial occlusion ranged from 11.8% to 17.8%, and overall patency rate postoperatively was 78.6%. No major thromboembolic events were reported. One study demonstrated an increase in neuroimaging abnormalities for patients undergoing ligation compared with vascular reconstruction. No studies demonstrated differences in functional neurodevelopmental testing.ConclusionsVascular reconstruction after ECMO decannulation has been reported since 1990. Although reconstruction does not appear to carry significant short-term morbidity, there are no large prospective studies or randomized controlled trials demonstrating its efficacy in improving neurologic outcomes in ECMO patients. There is also a paucity of data regarding outcomes in older children or long-term ramifications of vascular reconstruction.Copyright © 2023 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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