Objectives: To assess in-hospital neurologic (CNS) complications in adult patients undergoing veno-venous extracorporeal membrane oxygenation for respiratory failure.
Design: Retrospective analysis of the Extracorporeal Life Support Organization’s data registry.
Setting: Data reported to Extracorporeal Life Support Organization from 350 international extracorporeal membrane oxygenation centers during 1992–2015.
Patients: Adults (≥ 18 yr old) supported with veno-venous extracorporeal membrane oxygenation for respiratory failure.
Interventions: None.
Measurements and Main Results: We included 4,988 adults supported with veno-venous extracorporeal membrane oxygenation for respiratory failure. Neurologic injury was defined as brain death, seizures, stroke, and intracranial hemorrhage occurring during extracorporeal membrane oxygenation support. We used multivariable logistic regression to explore patient and extracorporeal membrane oxygenation factors associated with neurologic injury. Median age of the study cohort was 46 (interquartile range, 32–58). Four hundred twenty-six neurologic complications were reported in 356 patients (7.1%), and included 181 intracranial hemorrhage (42.5%), 100 brain deaths (23.5%), 85 stroke (19.9%), and 60 seizure events (14.1%). In-hospital mortality was significantly higher for those with CNS complications (75.8% vs 37.8%; p < 0.001) and varied by type of CNS injury; mortality was 79.6% in patients with intracranial hemorrhage, 68.2% in patients with stroke, and 50% in patients with seizures. Pre-extracorporeal membrane oxygenation cardiac arrest, continuous veno-venous hemofiltration, and hyperbilirubinemia during extracorporeal membrane oxygenation were associated with increased odds of neurologic injury.
Conclusions: Approximately 7% of adults supported with veno-venous extracorporeal membrane oxygenation for respiratory failure had neurologic injury. Intracranial hemorrhage was the most frequent type, and survival for patients with neurologic injury was poor. Future investigations should evaluate anticoagulation management as well as brain/extracorporeal membrane oxygenation interaction to reduce these life-threatening events.
1Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.
2Cardiology Unit, Cardiology Institute, University of L’Aquila, L’Aquila, Italy.
3Cardiac Surgery Unit, S.Croce Hospital, Cuneo, Italy.
4Cardiology Unit, Community Hospital, University of Brescia, Brescia, Italy.
5Extracorporeal Life Support Organization (ELSO), University of Michigan, Ann Arbor, MI.
6ECMO Department, University of Wurzburg, Wurzburg, Germany.
7Department of Internal Medicine, University Hospital of Regensburg, Regensburg, Germany.
8Department of Anesthesia, Ca’ Granda Hospital, Milan, Italy.
9Medical Intensive Care Unit, La Pitiè-Salpetriere Hospital, Paris, France.
10Department of Cardio-Thoracic Surgery Unit, Montefiore Hospital, New York, NY.
11ECMO Unit, Karolinska Hospital, Stockholm, Sweden.
12Pediatric Intensive Care Unit, Bambin GesĂą Hospital, Rome, Italy.
13Intensive Care and Emergency Medicine Department, Helios Frankelwaldklinik, Kronach, Germany.
14Cardiac Intensive Care Unit, Boston Children’s Hospital, Boston, MA.
Supported, in part, by a grant from Extracorporeal Life Support Organization.
Dr. Lorusso disclosed receiving an Extracorporeal Life Support Organization (ELSO) grant for clinical research. Dr. Mueller received funding from Novalung (Xenios) and Gambro/Baxter. Dr. Thiagarajan’s institution received funding from Bristol Myers Squibb, and he disclosed that he is the Co-chair of the Extracorporeal Membrane Oxygenation Registry of ELSO. The remaining authors have disclosed that they do not have any potential conflicts of interest.
For information regarding this article, E-mail: roberto.lorussobs@gmail.com
