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In-Hospital Neurologic Complications in Adult Patients Undergoing Venoarterial Extracorporeal Membrane Oxygenation: Results From the Extracorporeal Life Support Organization Registry

Lorusso, Roberto MD, PhD1; Barili, Fabio MD, PhD2; Mauro, Michele Di MD3; Gelsomino, Sandro MD, PhD1; Parise, Orlando MSc1; Rycus, Peter T.4; Maessen, Jos MD, PhD1; Mueller, Thomas MD5; Muellenbach, Raf MD, PhD6; Belohlavek, Jan MD, PhD7; Peek, Giles MD8; Combes, Alain MD, PhD9; Frenckner, Bjorn MD, PhD10; Pesenti, Antonio MD11; Thiagarajan, Ravi R. MBBS, MPH12

doi: 10.1097/CCM.0000000000001865
Online Clinical Investigations

Objectives: To elucidate the epidemiology, complication profiles, hospital outcome, and predisposing factors of CNS complications occurring during venoarterial extracorporeal membrane oxygenation in adults.

Design: Retrospective analysis of the Extracorporeal Life Support Organization registry.

Setting: Data reported to Extracorporeal Life Support Organization by 230 extracorporeal membrane oxygenation centers from 1992 to 2013.

Patients: Patients more than 16 years old supported with a single-run of venoarterial extracorporeal membrane oxygenation.

Interventions: None.

Measurements and Main Results: We examined 4,522 adult patients supported with venoarterial extracorporeal membrane oxygenation and included in the Extracorporeal Life Support Organization registry. Venoarterial extracorporeal membrane oxygenation was used for cardiac dysfunction in 3,005 patients (66.5%), cardiopulmonary resuscitation in 877 patients (19.4%), and respiratory failure in 640 patients (14.1%), respectively. Multivariate logistic regression was performed to identify factors independently associated with CNS injury. Neurologic complications occurred in 682 patients (15.1%), and included brain death in 358 patients (7.9%), cerebral infarction in 161 patients (3.6%), seizures in 83 patients (1.8%), and cerebral hemorrhage in 80 patients (1.8%). Multiple CNS complications in the same patient occurred in 70 cases. Hospital mortality in patients with CNS complications was 89%, compared with 57% in patients without (p < 0.001). In a multivariable model, age, pre-extracorporeal membrane oxygenation cardiac arrest, the use of inotropes on extracorporeal membrane oxygenation, and post-extracorporeal membrane oxygenation hypoglycemia were shown to be associated with CNS complications.

Conclusions: Neurologic complications in adult patients on venoarterial extracorporeal membrane oxygenation support are common and associated with poor survival. Further research should focus on better understanding and management of brain/extracorporeal membrane oxygenation interaction to avoid such catastrophic complications.

1Cardio-Thoracic Surgery Department, Maastricht University Medical Centre, Maastricht, The Netherlands.

2Cardiac Surgery Unit, Cardiac Surgery, Santa Croce Hospital, Cuneo, Italy.

3Institute of Cardiology, University of L’Aquila, L’Aquila, Italy.

4Extracorporeal Life Support Organization (ELSO), University of Michigan, Ann Arbor, MI.

5Department of Internal Medicine II, University Hospital of Regensburg, Regensburg, Germany.

6ECMO Department, University of Wurzburg, Wurzburg, Germany.

7Coronary Care Unit, Cardiovascular Medicine, General Teaching Hospital, Charles University, Prague, Czech Republic.

8Cardio-Thoracic Surgery Department, Glenfield Hospital, Leicester, United Kingdom.

9Internal Medicine Intensive Care Unit, La Pitiè Hospital, Paris, France.

10Division of Pediatric Surgery–Karolinska Hospital, Stockholm, Sweden.

11Anesthesiology Department–University of Milan, San Gerardo Hospital, Monza, Italy.

12Cardiac Intensive Care Unit, Boston Children’s Hospital, Boston, MA.

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Supported, in part, by a grant of Extracorporeal Life Support Organization.

Dr. Lorusso’s institution received funding from the Extracorporeal Life Support Organization (ELSO). Dr. Pesenti disclosed government work and received funding from Novalung, Maquet, and Gambro. Dr. Thiagarajan disclosed other support (Co-chair Extracorporeal Membrane Oxygenation registry of ELSO). His institution received funding from the National Heart, Lung, and Blood Institute PumpKin trial (Consultant to DCC) and from Bristol Myers Squibb (Events adjudication committee). The remaining authors have disclosed that they do not have any potential conflicts of interest.

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