Ariya Nu Chau

All Publications

• Favorable Vessel Patency Following Carotid Artery Reconstruction During Extracorporeal Membrane Oxygenation Decannulation in Children With Congenital Heart Disease. World journal for pediatric & congenital heart surgery Chau, A., Maskatia, S. A., Albuliwi, B., Martin, E., Ryan, K. R. 2025: 21501351251338830

  Abstract

  BackgroundCarotid artery ligation has been a common practice after extracorporeal membrane oxygenation (ECMO) decannulation due to the risks of embolization, cerebral infarction, aneurysm, and stenosis over time. Carotid artery reconstruction (CAR) after ECMO decannulation is increasingly used, though studies report variable stenosis rates. Data on CAR in children with heart disease, who may require carotid artery patency for future surgery or repeat ECMO, are lacking.ObjectiveTo evaluate carotid artery patency and the incidence of cerebral infarction in pediatric cardiac patients after CAR and ECMO decannulation.MethodsA retrospective review of children (0-21 years of age) who required venoarterial extracorporeal membrane oxygenation (VA-ECMO) via neck cannulation in the cardiovascular intensive care unit at a quaternary children's hospital (2015-2022) was conducted. Children who underwent CAR and survived to discharge were included.ResultsFifty-three children (ages 2 days to 21 years, median, 2 years of age) met the study criteria. Carotid artery imaging was performed in 25 children (47%), with 84% (21/25) showing unobstructed arteries. Imaging follow-up ranged from two days to four years, with a median of three months. Of 33 children who had post-ECMO head imaging, 11 showed new cerebral infarcts, with 4 of those infarcts diagnosed following transition to ventricular assist device (VAD). Given the variability of timing and modality of head imaging and the significant proportion of patients on a VAD, we are unable to determine the true incidence of new infarcts following CAR.ConclusionCarotid artery reconstruction after VA-ECMO decannulation in children with congenital heart disease shows early favorable vessel patency, but the long-term neurological benefits compared with ligation remain unclear. Further prospective studies are needed to evaluate long-term patency and neurological outcomes.

  View details for DOI 10.1177/21501351251338830

  View details for PubMedID 40405763

• THE COMFORT ZONE: IMPLEMENTATION OF AN ANALGESIA AND SEDATION PROTOCOL IN A PEDIATRIC CVICU Xie, A., Khlifi, K., Chau, A., Kameny, R., Presnell, L., Sandler, B. LIPPINCOTT WILLIAMS & WILKINS. 2025

  View details for DOI 10.1097/01.ccm.0001099484.89341.ef

  View details for Web of Science ID 001411564100034

• The end-tidal alveolar dead space fraction for risk stratification during the first week of invasive mechanical ventilation: an observational cohort study. Critical care (London, England) Bhalla, A. K., Chau, A., Khemani, R. G., Newth, C. J. 2023; 27 (1): 54

  Abstract

  BACKGROUND: The end-tidal alveolar dead space fraction (AVDSf=[PaCO2-PETCO2]/PaCO2) is a metric used to estimate alveolar dead space. Higher AVDSf on the first day of mechanical ventilation is associated with mortality and fewer ventilator-free days. It is not clear if AVDSf is associated with length of ventilation in survivors, how AVDSf performs for risk stratification beyond the first day of ventilation, or whether AVDSf adds predictive value to oxygenation (oxygenation index [OI]) or severity of illness (Pediatric Risk of Mortality [PRISM III]) markers.METHODS: Retrospective single-center observational cohort study of children and young adults receiving invasive mechanical ventilation. In those with arterial or capillary blood gases, AVDSf was calculated at the time of every blood gas for the first week of mechanical ventilation.RESULTS: There were 2335 children and young adults (median age 5.8years [IQR 1.2, 13.2]) enrolled with 8004 analyzed AVDSf values. Higher AVDSf was associated with mortality and longer length of ventilation in survivors throughout the first week of ventilation after controlling for OI and PRISM III. Higher OI was not associated with increased mortality until≥48h of ventilation after controlling for AVDSf and PRISM III. When using standardized variables, AVDSf effect estimates were generally higher than OI for mortality, whereas OI effect estimates were generally higher than AVDSf for the length of ventilation in survivors. An AVDSf>0.3 was associated with a higher mortality than an AVDSf<0.2 within each pediatric acute respiratory distress syndrome severity category. The maximum AVDSf within 12h of intensive care unit admission demonstrated good risk stratification for mortality (AUC 0.768 [95% CI 0.732, 0.803]). AVDSf did not improve mortality risk stratification when added to PRISM III but did improve mortality risk stratification when added to the gas exchange components of PRISM III (minimum 12-h PaO2 and maximum 12-h PCO2) (p<0.00001).CONCLUSIONS: AVDSf is associated with mortality and length of ventilation in survivors throughout the first week of invasive mechanical ventilation. Some analyses suggest AVDSf may better stratify mortality risk than OI, whereas OI may better stratify risk for prolonged ventilation in survivors than AVDSf.

  View details for DOI 10.1186/s13054-023-04339-3

  View details for PubMedID 36759925