Neurological Outcome According to the Site of Cannulation in Septic Children Supported by Venoarterial Extracorporeal Membrane Oxygenation. Issue 12 (December 2021)

• Record Type: Journal Article
• Authors: Chenouard, Alexis; Liet, Jean-Michel; Maminirina, Pierre; Denis, Manon; Tonna, Joseph; Rycus, Peter; Joram, Nicolas; Bourgoin, Pierre
• Is Part Of: ASAIO journal. Volume 67:Issue 12(2021)
• Publication Date: 2021-12
• Subjects: extracorporeal membrane oxygenation -- pediatric -- sepsis -- septic shock -- cannulation site -- carotid artery -- neurologic injury; Artificial organs -- Periodicals; 617
• DOI: 10.1097/MAT.0000000000001532
• Languages: English
• ISSNs: 1058-2916

Abstract

Abstract : The impact of cervical cannulation on neurologic outcome has not been yet studied among children receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO) in the context of severe sepsis or septic shock. A retrospective cohort study was performed using the extracorporeal life support organization (ELSO) registry. A total of 559 children weighing less than 20 kg with a primary or secondary diagnosis of severe sepsis, septic shock or toxic shock syndrome were included between January 1, 2010, and December 31, 2019. Cervical cannulation was performed in 485 children (87%) and central cannulation in 74 children (13%). The prevalence of acute neurologic event (ANE) was 32%, including clinical and/or electroencephalographic seizures, cerebral infarction, cerebral hemorrhage, and/or brain death. In multivariable analysis, we did not find an association between cervical cannulation and greater/lesser odds of ANE during ECMO (adjusted odds ratio [aOR] = 1.39, 95% confidence interval [CI] 0.72–2.65; P = 0.326). Only pre-ECMO acidosis was independently associated with the development of ANE (pH < 6.99; aOR = 2.71, 95% CI 1.34–5.49; P = 0.006; pH 6.99 to <7.12; aOR = 2.57, 95% CI 1.37–4.82; P = 0.003). Thus, the site of cannulation appears not as a modifiable neurologic risk factor in this young septic population.