Pediatric Neck Vessel Repair Following Extracorporeal Membrane Oxygenation Decannulation: Assessing Stroke Risk, Long-Term Neurologic Outcomes, and Vessel Patency

Pediatric extracorporeal membrane oxygenation (ECMO) decannulation practices vary widely regarding ligation versus repair of the common carotid artery (CCA) and internal jugular vein (IJV) with potential implications for neurologic outcomes. We examined rates of ischemic cerebral vascular accident (CVA) and vessel patency in pediatric ECMO patients following decannulation. A retrospective review of pediatric ECMO patients (2009-2023) cannulated via cervical approach was conducted, excluding palliative decannulations. Clinical outcome measures were evaluated using descriptive and inferential statistics. Of 140 patients, 49 (35.0%) underwent vessel repair. These patients were more likely to have a cardiac indication for ECMO (57.1% vs . 19.8%; p < 0.001). Median time from cannulation to vessel repair was 97 hours (interquartile range [IQR]: 73-170). Rates of ischemic CVA were not different between groups (8.2% repaired vs. 8.8% ligated; p = 0.899). Surveillance imaging was performed in 49% of repaired patients, with a 95.8% CCA and 55.5% IJV patency rate. High CCA patency rates were observed following cervical vessel repair, with no difference in ischemic CVA compared with ligation. Vessel repair may be beneficial in populations at risk for future mechanical support needs, such as those with complex cardiac disease, as it preserves the option for subsequent ECMO cannulation.