Increased Stroke Risk in Children and Young Adults on Extracorporeal Life Support with Carotid Cannulation

Patients on extracorporeal life support (ECLS) are at risk for central nervous system (CNS) injury. One potentially modifiable risk factor is site of arterial cannulation in venoarterial (VA) ECLS, as in most cases one can choose the femoral or carotid artery. There is acute alteration in cerebral blood flow with carotid cannulation, potentially increasing the risk of stroke. Children may have lower risk of stroke with carotid cannulation compared with adults because of impaired cerebral circulation with aging. Our objective was to evaluate risk of stroke with carotid versus femoral cannulation and determine whether this differs between children and adults. Using the Extracorporeal Life Support Organization Registry, we evaluated patients 6-40 years old on VA ECLS during 2000-2012. We used multivariable logistic regression to estimate the relationship between location of arterial cannulation and stroke. We included an interaction term to assess whether this was modified by age. One thousand five hundred eighteen patients were included in the analysis. There was a fourfold increased odds of CNS infarct (odds ratio [OR]: 4.03; 95% CI: 2.17-7.46) with carotid cannulation. This estimate was not modified by age. There is increased likelihood of stroke with carotid cannulation in patients 6-40 years old in comparison with femoral cannulation during VA ECLS.