Neonatal Carotid Artery and Internal Jugular Vein Management Practices at Extracorporeal Membrane Oxygenation Decannulation: No Standard Approach.

Autor: Linden AF; Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, 1405 Clifton Road, NE, Atlanta, GA, 30322, USA. Electronic address: Allison.Linden@choa.org., Howk AA; Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, 1405 Clifton Road, NE, Atlanta, GA, 30322, USA., Billimoria Z; Division of Neonatology, Department of Pediatrics, University of Washington, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA., Devine M; Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA., DiGeronimo R; Division of Neonatology, Department of Pediatrics, University of Washington, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA., Gray B; Department of Surgery, Indiana University, 705 Riley Hospital Dr, Bloomington, IN, 46202, USA., Hamrick SE; Division of Neonatology, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, 1405 Clifton Road, NE, Atlanta, GA, 30322, USA., Keene SD; Division of Neonatology, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, 1405 Clifton Road, NE, Atlanta, GA, 30322, USA., Rintoul N; Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA., Mahmood B; UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, Division of Newborn Medicine, University of Pittsburgh School of Medicine, 4401 Penn Ave, Pittsburgh, PA, 15224, USA.
Jazyk: angličtina
Zdroj: Journal of pediatric surgery [J Pediatr Surg] 2023 Nov; Vol. 58 (11), pp. 2196-2200. Date of Electronic Publication: 2023 Jul 24.
DOI: 10.1016/j.jpedsurg.2023.07.007
Abstrakt: Background: There are currently no commonly accepted standardized guidelines for management of cervical vessels at neonatal extracorporeal membrane oxygenation (ECMO) decannulation. This study investigates neonatal ECMO decannulation practices regarding management of the carotid artery and internal jugular vein, use of post-repair anticoagulation, and follow-up imaging.
Methods: A survey was distributed to the 37 institutions in the Children's Hospitals Neonatal Consortium. Respondents reported their standard approach to carotid artery and internal jugular vein management (ligation or repair) at ECMO decannulation by their pediatric surgery and cardiothoracic (CT) surgery teams as well as post-repair anticoagulation practices and follow-up imaging protocols.
Results: The response rate was 95%. Pediatric surgeons performed most neonatal respiratory ECMO cannulations (88%) and decannulations (85%), while all neonatal cardiac ECMO cannulations and decannulations were performed by CT surgeons. Pediatric surgeons overwhelmingly ligate both vessels (90%) while CT surgeons typically repair both vessels at decannulation (83%). Of the responding centers that repair, 28% (7) have a standard anticoagulation protocol after neck vessel repair. While 52% (13) of centers routinely image cervical vessel patency at least once post repair, most do not subsequently repeat neck vessel imaging.
Conclusions: Significant practice differences exist between pediatric and CT surgeons regarding the approach to cervical vessels at neonatal ECMO decannulation. For those centers that do repair the vessels there is little uniformity in post-repair anticoagulation or imaging protocols. There is a need to develop standardized cervical vessel management guidelines for neonatal ECMO patients and to study their impact on both short- and long-term outcomes.
Level of Evidence: IV.
Competing Interests: Declaration of competing interest None.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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