• Sarah A Teele, Joshua W Salvin, Cindy S Barrett, Peter T Rycus, Francis Fynn-Thompson, Peter C Laussen, and Ravi R Thiagarajan.
• 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.
• Pediatr Crit Care Me. 2014 May 1;15(4):355-61.

ObjectivesTo 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.DesignRetrospective analysis of data from the Extracorporeal Life Support Organization registry.SettingNeonatal and pediatric medical/surgical and cardiac ICUs of 118 international tertiary care centers worldwide.PatientsPediatric 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.InterventionsNone.Measurements And Main ResultsTwo 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]).ConclusionsCarotid 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.

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