Massachusetts Chapter of the American College of Surgeons

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To Drain or Not to Drain? An ELSO Database Review of Neonatal Respiratory VA ECMO
Niloufar Hafezi1,2, Buria Naeem2, Cameron Colgate2, Kay Sichting3, Alejandro Garcia4, Michael Hobson2, Brian Gray2
1Baystate Medical Center, Springfield, MA; 2Indiana University School of Medicine, Indianapolis, IN; 3Peyton Manning Children's Hospital, Indianapolis, IN; 4Johns Hopkins School of Medicine, Baltimore, MD

Background:
Extracorporeal membrane oxygenation (ECMO) is an advanced life support modality but carries high morbidity and mortality. Cephalic drains have been theorized to prevent high intracranial pressures and reduce ECMO neurologic morbidity, however, these benefits are debated. Here, we review the Extracorporeal Life Support Organization (ELSO) database and predict that cephalic drain use is not associated with lower neurologic morbidity in neonatal respiratory VA ECMO.

Methods:
Neonates on respiratory VA ECMO undergoing an uncomplicated neck cannulation with and without cephalic drain placement between 2012-2020 were compared. Those undergoing chest or femoral cannulation, site or modality changes were excluded. The primary outcomes of interest were neurologic morbidity and mortality. Multiple regression models identified independent predictors for the outcomes of interest. p<0.05 was significant.

Results:
Of 4,141 patients, 159(3.8%) had cephalic drains while 3,982(96.2%) did not. There were no differences in gender(p=0.51), race(p=0.18), age(p=0.08), gestational age(p=0.77), ECPR cannulation(p=0.36), need for circuit change(p=0.35), or ECMO duration(p=0.39) between the groups. No differences in mortality(p= 0.49) or neurologic morbidity(p= 0.21) were also observed. Cephalic drains use was not identified as an independent predictor for neurologic morbidity and mortality.

Conclusion:
Cephalic drain use during neonatal respiratory VA ECMO is not associated with differences in ECMO mortality and neurologic morbidity, and the decision for its placement in this population should not be solely for the purpose of neuroprotection.


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