CHILDHOOD CAROTID INTIMA MEDIAL THICKNESS FOLLOWING VENOARTERIAL NEONATAL EXTRACORPOREAL MEMBRANE OXYGENATION: EVIDENCE OF CARDIOVASCULAR DISEASE?

Abstract

Background As of 2006, the Extracorporeal Life Support Organization registry reported 11,786 neonatal venoarterial (VA) extracorporeal membrane oxygenation (ECMO) survivors with their right carotid artery ligated for the procedure. Objective To compare left carotid intima medial thickness (CIMT) and biochemical markers for atherogenesis in VA ECMO survivors to normal controls. Methods Children9s Hospital Los Angeles VA ECMO survivors and healthy subjects born before 1994 were invited to participate in a matched control prospective study. ECMO survivors were matched to controls based on chronological age and percentile body mass index (%BMI). Using a high-resolution B-mode carotid ultrasonography and a 15 MHz transducer, visualization of the carotid arterial wall was obtained according to the method of Hodis et al by a trained sonographer blinded to the status of the participants (patient vs control). An automated computerized edge detection software measured CIMT from the far wall of the left carotid artery. Lipid profiles, ultrasensitive CRP, ferritin, and homocystine levels were also collected. Results Thirty-one VA ECMO survivors were matched to 31 healthy controls. No significant differences were found between ECMO survivors and controls for age (16.8 ± 0.3 vs 16.2 ± 0.3 years), weight (68.5 ± 3.3 vs 69.8 ± 2.9 kg), %BMI (73.5 ± 5.2 vs 73.5 ± 5.3%), total fat composition, lipid profiles, ultrasensitive CRP, ferritin, or homocystine levels. Significant differences between ECMO and controls subjects were found in measurements of systolic left CIMT (0.42 ± 0.01 vs 0.39 ± 0.01 mm; p = .03) and mean (systolic-diastolic) left CIMT (0.40 ± 0.01 vs 0.38 ± 0.01 mm; p = .04). Conclusion VA ECMO survivors, between 12 and 20 years of age, have a significant increase in left systolic and mean CIMT compared with controls. Due to their dependence on left carotid blood flow to maintain adequate cerebral perfusion, VA ECMO patients may be at risk of significant cardiovascular disease in adulthood. Further studies need to focus on the pathogenesis of intimal thickening and on cardiovascular evaluation of VA ECMO survivors into adulthood.