Cerebral Hemodynamic Impact in Children Depending on the Technique of Carotid Artery Decanulation Technique After Extracorporeal Membrane Oxygenation: Modeling of Intra-cerebral Vascular Flows
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Extra Corporeal Membrane Oxygenation
- Sponsor
- Assistance Publique - Hôpitaux de Paris
- Enrollment
- 30
- Locations
- 1
- Primary Endpoint
- Intracerebral arterial flows of patients treated with ECMO
- Status
- Recruiting
- Last Updated
- 7 months ago
Overview
Brief Summary
Extra corporeal membrane oxygenation (ECMO) is a transient supplementation technique that alleviates hemodynamic and ventilatory failure. Its implementation requires carotid arterial and jugular venous cannulation in newborns or children weighing less than 20 kg. The impact of ECMO on arterial circulation was studied by Doppler ultrasound and shows a redistribution of flows within the circle of Willis.
This study aims to model cerebral flow in children who have been cared from jugulocarotid ECMO and compare cerebral hemodynamics according to the technique of reconstruction of the common carotid artery after decanulation (reconstruction or ligation).
Detailed Description
Extra corporeal membrane oxygenation (ECMO) is a transient supplementation technique that alleviates hemodynamic and ventilatory failure. Its implementation requires carotid arterial and jugular venous cannulation in newborns or children weighing less than 20 kg. The impact of ECMO on arterial circulation was studied by Doppler ultrasound and shows a redistribution of flows within the circle of Willis. When ECMO is stopped, carotid decanulation is done either by ligation or by reconstruction, depending on the practices of the surgical team and the peroperative findings. The reconstruction allows a restoration of blood flow to the internal carotid artery and the middle cerebral artery with a disappearance of compensation by the circle of Willis. Vascular flow modeling is a computational method derived from imaging for the hemodynamic study of fluids, including pressures and flow rates at different points in a vessel. Data from the literature on the modeling of cerebral vascularization in newborns are scarce. This study aims to model cerebral flow in children who have been cared from jugulocarotid ECMO and compare cerebral hemodynamics according to the technique of reconstruction of the common carotid artery after decanulation (reconstruction or ligation).
Investigators
Eligibility Criteria
Inclusion Criteria
- •For everyone :
- •Information and non-opposition of holders of parental authority
- •Newborn, infant and child \<20kg
- •Hospitalization in pediatric and neonatal intensive care unit (PICU) of Trousseau Hospital
- •Performing a Magnetic Resonance Angiography (MRA) as part of the treatment
- •For patients treated with ECMO: study population
- •Hemodynamic or respiratory failure
- •Requiring the use of extracorporeal circulation with jugulo-carotid cannulation
- •Weaned alive off Extra corporeal membrane oxygenation (ECMO)
- •For patients with hypoxic-ischemic encephalopathy: control population
Exclusion Criteria
- •Contraindication to MRA
- •Opposition of holders of parental authority
Outcomes
Primary Outcomes
Intracerebral arterial flows of patients treated with ECMO
Time Frame: 1 month
Comparison of intracerebral arterial flows according to the technique of reconstruction of the common carotid artery (reconstruction or ligation) after decanulation from data of MRA performed in weaned living patients off ECMO using computational fluid dynamic.
Secondary Outcomes
- Modeling of the flow of internal carotid arteries in their extra-cranial portion in children after ECMO(1 month)
- Cerebral vascularization of patients treated for hypoxic-ischemic encephalopathy(1 month)
- Intracerebral arterial flows of patients treated for hypoxic-ischemic encephalopathy(1 month)