WOFAPS 2025 8th World Congress of Pediatric Surgery

Nadezhda Erokhina, Vasily Shumikhin, Olga Mokrushina, Elena Zilbert, Maria Boguslavskaya, Grigorij Dibrivnyj, Aza Zafesova, Tat'yana Voroncova, Irina Nikolaeva, Elizaveta Melkumyan

Pirogov Russian National Research Medical University, Moscow, Russia

Background:

ECMO is a critical intervention for neonatal patients with severe respiratory failure unresponsive to conventional therapy. Veno-arterial ECMO requires cannulation of major cervical vessels, raising concerns about potential long-term vascular and neurological sequelae.

Objective:

To assess the long-term outcomes of internal jugular vein and common carotid artery cannulation in neonates treated with veno-arterial ECMO, with a focus on vascular patency, cerebral perfusion, and neurodevelopmental status following surgical reconstruction during decannulation.

Methods:

A retrospective cohort study was conducted at the Filatov Children's City Clinical Hospital (Moscow) from 2016 to 2024, including 66 neonates (mean age: 4.76 ± 4.83 days; mean weight: 3490.7 ± 567.36 g) who underwent right-sided vascular cannulation for ECMO. The mean ECMO duration was 8.95 ± 7.3 days. Surgical reconstruction of cannulated vessels was performed in 61.4% of cases during decannulation, while partial or complete ligation was performed in the remainder. Twenty patients with vascular reconstruction were enrolled in long-term follow-up, which included Doppler ultrasonography, brain MRI, fundus examination, and neurologic evaluation.

Results:

All reconstructed vessels remained patent on DUS, although asymmetry in vessel diameter and flow velocity was observed. No critical flow impairment was identified. Brain MRI findings indicated post-hypoxic lesions in the majority, with no evidence of perfusion-related focal injury attributable to cannulation. Fundus examinations revealed no ipsilateral retinal pathology; mild retinal angiopathy was observed in some cases, without consistent lateralization. Neurological assessments showed age-appropriate development in most patients, with isolated cases of cerebroasthenic syndrome, delayed development, and hemiparesis secondary to intracerebral hemorrhage.

Conclusion:

Surgical cannulation and subsequent reconstruction of the internal jugular vein and common carotid artery in neonates undergoing ECMO is not associated with focal cerebral perfusion deficits, ophthalmic abnormalities, or long-term focal neurological impairments. Observed neurological and imaging abnormalities were primarily attributed to underlying disease and hypoxic injury rather than vascular access.