Cannulation of the external iliac artery in a newborn with interrupted aortic arch and premature closure of the ductus

Abstract After an uneventful vaginal delivery at term, the baby deteriorated within a few minutes and required intubation. Echocardiography showed an interrupted aortic arch with no significant ductus blood flow. Prostaglandin infusion improved oxygenation temporarily. Rising lactate levels indicated inadequate tissue oxygenation. In spite of inotropic support, several episodes of bradycardia requiring CPR occurred. At ten hours of life, the baby was cannulated for veno-arterial ECMO with drainage from the right internal jugular vein. In order to ensure perfusion in the lower body, blood was infused via an arterial cannula inserted in the right external iliac artery. The patient was transferred on ECMO to a pediatric surgical heart center. After stabilization, the aortic malformation was repaired via a left thoracotomy during hypothermia with the same cannulation, the baby was decannulated and the iliac artery repaired. At four weeks of age, the baby was discharged home on room air and full enteral feeding. It is concluded that arterial cannulation of the external iliac artery for ECMO in a newborn is an alternative, if exclusive perfusion of the lower body is desired or if the right carotid artery is unavailable.