Modeling of Intracerebral Vascularization After Extracorporeal Membrane Oxygenation in Children

Study Overview
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Brief Summary
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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
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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).

Official Title
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Cerebral Hemodynamic Impact in Children Depending on the Technique of Carotid Artery Decanulation Technique After Extracorporeal Membrane Oxygenation: Modeling of Intra-cerebral Vascular Flows

Conditions
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Extra Corporeal Membrane Oxygenation, Decanulated Alive

Intervention / Treatment
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* Other: Magnetic Resonance Angiography (MRA) additional acquisition time
* Other: Modeling cerebral vascularization


Participation Criteria
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Eligibility Criteria
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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 hypoxic-ischemic encephalopathy diagnosed at birth Exclusion Criteria: Contraindication to gadolinium contrast medium injection (study population) Contraindication to MRA Opposition of holders of parental authority

Ages Eligible for Study
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Maximum Age: 17 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Patients<br>Newborns, infants and children hospitalized in pediatric intensive care unit (PICU) at Trousseau Hospital, having been treated with jugulocarotid ECMO and weaned alive off ECMO. | Other: Modeling cerebral vascularization<br>* The modeling of cerebral vascularization from CRIMSON software (CaRdiovascular Integrated Modeling & Simulation) requires several inputs: The MRA images The cardiac function curve The cerebral blood flow Measurement of systolic, diastolic and mean arterial blood pressure<br>|
| Controls<br>Newborns treated for hypoxic-ischemic encephalopathy in the PICU of Trousseau Hospital. | Other: Magnetic Resonance Angiography (MRA) additional acquisition time<br>* Additional acquisition time, time of flight, during brain MRA of the care allowing to obtain the same quality of vascular anatomical visualization as the brain MRA with gadolinium contrast medium injection performed for the care of the patients treated with jugulocarotid ECMO.<br>Other: Modeling cerebral vascularization<br>* The modeling of cerebral vascularization from CRIMSON software (CaRdiovascular Integrated Modeling & Simulation) requires several inputs: The MRA images The cardiac function curve The cerebral blood flow Measurement of systolic, diastolic and mean arterial blood pressure<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Intracerebral arterial flows of patients treated with ECMO | 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 CRIMSON digital fluid mechanics software. | 1 month | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Modeling of the flow of internal carotid arteries in their extra-cranial portion in children after ECMO | Brain Magnetic Resonance Angiography (MRA) with gadolinium contrast medium injection | 1 month | 
| Cerebral vascularization of patients treated for hypoxic-ischemic encephalopathy | Additional acquisition time, time of flight, during brain Magnetic Resonance Angiography. (MRA) of the care. Modeling of the normal cerebral vascularization in children and infants / newborns. | 1 month | 
| Intracerebral arterial flows of patients treated for hypoxic-ischemic encephalopathy | Comparison of intracerebral arterial flows between patients treated with ECMO and those treated for anoxo-ischemia from data of MRA and by using CRIMSON digital fluid mechanics software. | 1 month | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Extra corporeal membrane oxygenation, Pediatric patients, Arterial circulation, Techniques of carotid decanulation, Circle of Willis, Magnetic Resonance Angiography