Friend or Foe? Venoarterial ECMO via Carotid Artery "Jump Graft": A Case Series

Abstract

Extracorporeal life support is used in adult and pediatric patients for refractory cardiac and respiratory failure. The great arteries and veins of the neck and groin are often used for cannulation to extracorporeal membrane oxygenation (ECMO). Newer cannulation techniques use the subclavian or axillary arteries, in addition to synthetic grafts anastomosed in end-to-side fashion, from which the cannula is positioned. These newer techniques can prevent need for ligation and sacrifice of important major vessels that is often undertaken in "traditional" direct surgical cannulation strategies. To our knowledge this graft technique has not been performed in pediatric ECMO patients. We describe a case series of nine patients from 2012 to 2017 supported with venoarterial (V-A) ECMO utilizing a synthetic Gore-Tex^® "jump graft" sewn in an end-to-side fashion to the right carotid artery, for the arterial cannula insertion. Each patient's hospital course was reviewed with particular consideration given to disease process, site of cannulation, neurologic examination abnormalities noted during ECMO, computed tomography (CT) or magnetic resonance imaging (MRI) evidence of intracranial hemorrhage, and outcomes. Eight of nine patients were successfully cannulated utilizing this technique without neurologic complication. One suffered catastrophic intracerebral hemorrhage. This series is limited by small sample size and single center experience. Further work is needed to determine the advantages and disadvantages of utilizing a synthetic graft in pediatric V-A ECMO.

Keywords: ECMO; critical care; extracorporeal membrane oxygenation; pediatrics; synthetic graft..

Figure 1.

Cerebral near-infrared spectroscopy (NIRS) for Patient 8 with hyperemia to the head and neck who later developed catastrophic intracerebral hemorrhage.

Figure 2.

(left) Outflow graft and arterial cannula on subclavian artery and (right) schematic diagram of subclavian artery cannulation as an outflow of extracorporeal membrane oxygenation circuit. Used with permission from Kervan U, Kocabeyoglu S, Sert DE, et al. A novel technique of subclavian artery cannulation for venoarterial extracorporeal membrane oxygenation.