Cerebral perfusion may change depending on arterial cannulation site and may affect the incidence of neurologic adverse events in post-cardiotomy extracorporeal life support (ECLS). The current study compares patients' neurologic outcomes with three commonly used arterial cannulation strategies (aortic vs. subclavian/axillary vs. femoral artery) to evaluate if each ECLS configuration is associated with different rates of neurologic complications. This retrospective, multicenter (34 centers), observational study included adults requiring post-cardiotomy ECLS between January 2000 and December 2020 present in the Post-Cardiotomy Extracorporeal Life Support (PELS) Study database. Patients with Aortic, Subclavian/Axillary and Femoral cannulation were compared on the incidence of a composite neurological end-point (ischemic stroke, cerebral hemorrhage, brain edema). Secondary outcomes were overall in-hospital mortality, neurologic complications as cause of in-hospital death, and post-operative minor neurologic complications (seizures). Association between cannulation and neurological outcomes were investigated through linear mixed-effects models. This study included 1897 patients comprising 26.5% Aortic (n = 503), 20.9% Subclavian/Axillary (n = 397) and 52.6% Femoral (n = 997) cannulations. The Subclavian/Axillary group featured a more frequent history of hypertension, smoking, diabetes, previous myocardial infarction, dialysis, peripheral artery disease and previous stroke. Neuro-monitoring was used infrequently in all groups. Major neurologic complications were more frequent in Subclavian/Axillary (Aortic: n = 79, 15.8%; Subclavian/Axillary: n = 78, 19.6%; Femoral: n = 118, 11.9%; p < 0.001) also after mixed-effects model adjustment (OR 1.53 [95% CI 1.02–2.31], p = 0.041). Seizures were more common in Subclavian/Axillary (n = 13, 3.4%) than Aortic (n = 9, 1.8%) and Femoral cannulation (n = 12, 1.3%, p = 0.036). In-hospital mortality was higher after Aortic cannulation (Aortic: n = 344, 68.4%, Subclavian/Axillary: n = 223, 56.2%, Femoral: n = 587, 58.9%, p < 0.001), as shown by Kaplan–Meier curves. Anyhow, neurologic cause of death (Aortic: n = 12, 3.9%, Subclavian/Axillary: n = 14, 6.6%, Femoral: n = 28, 5.0%, p = 0.433) was similar. In this analysis of the PELS Study, Subclavian/Axillary cannulation was associated with higher rates of major neurologic complications and seizures. In-hospital mortality was higher after Aortic cannulation, despite no significant differences in incidence of neurological cause of death in these patients. These results encourage vigilance for neurologic complications and neuromonitoring use in patients on ECLS, especially with Subclavian/Axillary cannulation.

中文翻译：

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接受主动脉插管、锁骨下动脉插管与股动脉插管进行心脏术后体外生命支持的患者的神经系统并发症：PELS 观察性多中心研究的结果


脑灌注可能会根据动脉插管部位而变化，并可能影响心脏切开术后体外生命支持 (ECLS) 中神经系统不良事件的发生率。目前的研究将患者的神经系统结果与三种常用的动脉插管策略（主动脉与锁骨下/腋动脉与股动脉）进行比较，以评估每种 ECLS 配置是否与不同的神经系统并发症发生率相关。这项回顾性、多中心（34 个中心）观察性研究纳入了心脏切开术后体外生命支持 (PELS) 研究数据库中 2000 年 1 月至 2020 年 12 月期间需要进行心脏切开术后 ECLS 的成年人。比较了主动脉、锁骨下/腋窝和股动脉插管患者的复合神经学终点（缺血性中风、脑出血、脑水肿）的发生率。次要结局是院内总体死亡率、院内死亡原因的神经系统并发症以及术后轻微神经系统并发症（癫痫发作）。通过线性混合效应模型研究插管与神经系统结果之间的关联。这项研究包括 1897 名患者，其中 26.5% 为主动脉插管 (n = 503)，20.9% 为锁骨下/腋窝插管 (n = 397)，52.6% 为股骨插管 (n = 997)。锁骨下/腋窝组的高血压、吸烟、糖尿病、既往心肌梗塞、透析、外周动脉疾病和既往中风病史更常见。所有组中都很少使用神经监测。混合效应模型后，锁骨下/腋窝的主要神经系统并发症也更常见（主动脉：n = 79，15.8%；锁骨下/腋窝：n = 78，19.6%；股骨：n = 118，11.9%；p < 0.001）调整（OR 1.53 [95% CI 1.02–2.31]，p = 0.041）。 癫痫发作在锁骨下/腋窝 (n = 13, 3.4%) 中比主动脉 (n = 9, 1.8%) 和股动脉插管 (n = 12, 1.3%, p = 0.036) 更常见。主动脉插管后的院内死亡率较高（主动脉：n = 344, 68.4%，锁骨下/腋窝：n = 223, 56.2%，股骨：n = 587, 58.9%，p < 0.001），如 Kaplan-Meier 所示曲线。无论如何，神经系统死亡原因（主动脉：n = 12, 3.9%，锁骨下/腋窝：n = 14, 6.6%，股骨：n = 28, 5.0%，p = 0.433）相似。在 PELS 研究的分析中，锁骨下/腋窝插管与主要神经系统并发症和癫痫发作的较高发生率相关。主动脉插管后的院内死亡率较高，尽管这些患者的神经原因死亡发生率没有显着差异。这些结果鼓励 ECLS 患者（尤其是锁骨下/腋窝插管患者）对神经系统并发症和神经监测的使用保持警惕。