Risk of Central Nervous System Injury by Location of Arterial Cannulation and Age in Veno-Arterial ECLS

Abstract

Objective: The objective of this study was to determine whether the risk of central nervous system (CNS) injury is higher in carotid compared to femoral artery cannulation in veno-arterial extracorporeal life support (VA-ECLS) and to evaluate whether this differs by age. Methods: We conducted a retrospective cohort study of patients 3-55 years old treated with VA-ECLS between 1989-2012 utilizing the Extracorporeal Life Support Organization Registry. We used logistic regression to estimate the association between site of cannulation and CNS injury adjusting for confounders and assessing for effect modification by age. Results: We found a three fold increased odds of CNS infarction with carotid as opposed to femoral artery cannulation (OR 2.99, 95% CI 1.86 - 4.81), which was not appreciably different by age group. Conclusion: In this study, carotid artery cannulation was associated with an increased likelihood of CNS injury as compared to femoral artery cannulation, which differed little by age.