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Severe Respiratory Failure, Extracorporeal Membrane Oxygenation, and Intracranial Hemorrhage*

Lockie, Christopher J. A. MBBS1; Gillon, Stuart A. FFICM2; Barrett, Nicholas A. FCICM1; Taylor, Daniel MBBS1; Mazumder, Asif FRCR3; Paramesh, Kaggere MBBS3; Rowland, Katie MBBS1; Daly, Kathleen PhD1; Camporota, Luigi PhD1; Meadows, Christopher I. S. FFICM1; Glover, Guy W. FFICM1; Ioannou, Nicholas FFICM1; Langrish, Christopher J. FFICM1; Tricklebank, Stephen FFICM1; Retter, Andrew MBBS1; Wyncoll, Duncan L. A. FFICM1

doi: 10.1097/CCM.0000000000002579
Clinical Investigations

Objectives: For patients supported with veno-venous extracorporeal membrane oxygenation, the occurrence of intracranial hemorrhage is associated with a high mortality. It is unclear whether intracranial hemorrhage is a consequence of the extracorporeal intervention or of the underlying severe respiratory pathology. In a cohort of patients transferred to a regional severe respiratory failure center that routinely employs admission brain imaging, we sought 1) the prevalence of intracranial hemorrhage; 2) survival and neurologic outcomes; and 3) factors associated with intracranial hemorrhage.

Design: A single-center, retrospective, observational cohort study.

Setting: Tertiary referral severe respiratory failure center, university teaching hospital.

Patients: Patients admitted between December 2011 and February 2016.

Intervention: None.

Measurements and Main Results: Three hundred forty-two patients were identified: 250 managed with extracorporeal support and 92 managed using conventional ventilation. The prevalence of intracranial hemorrhage was 16.4% in extracorporeal membrane oxygenation patients and 7.6% in conventionally managed patients (p = 0.04). Multivariate analysis revealed factors independently associated with intracranial hemorrhage to be duration of ventilation (d) (odds ratio, 1.13 [95% CI, 1.03–1.23]; p = 0.011) and admission fibrinogen (g/L) (odds ratio, 0.73 [0.57–0.91]; p = 0.009); extracorporeal membrane oxygenation was not an independent risk factor (odds ratio, 3.29 [0.96–15.99]; p = 0.088). In patients who received veno-venous extracorporeal membrane oxygenation, there was no significant difference in 6-month survival between patients with and without intracranial hemorrhage (68.3% vs 76.0%; p = 0.350). Good neurologic function was observed in 92%.

Conclusions: We report a higher prevalence of intracranial hemorrhage than has previously been described with high level of neurologically intact survival. Duration of mechanical ventilation and admission fibrinogen, but not exposure to extracorporeal support, are independently associated with intracranial hemorrhage.

1Department of Critical Care, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom.

2Department of Critical Care, Queen Elizabeth University Hospital, Glasgow, United Kingdom.

3Department of Radiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom.

*See also p. 1781.

Dr. Barrett received support for travel from Maquet; his institution served as a board member for ALung and received grant support from ALung and Corpak; and he received educational funding from Maquet, Corpak, Johnson & Johnson, Draeger, and Mitsubishi Tanabe Pharmaceuticals. Dr. Daly received educational and research support from ALung Incorporated, Corpak Medical Systems, Draeger, Maquet, Gettinge Group, and Mitsubishi Pharmaceuticals. Dr. Glover received funding from Bard Medical (consulting). Dr. Wyncoll served as a board member for Astellas; lectured for HealthCare 21, Astellas, Pfizer, Sage, Johnson & Johnson, and Bioproducts; received support for the development of educational presentations from Astellas; and received funding from Pfizer (board member), Astellas (board member), and Sage, Healthcare21, Johnson & Johnson, and Bioproducts speaker bureaus (all unrelated to this work). The remaining authors have disclosed that they do not have any potential conflicts of interest.

Address requests for reprints to: Christopher Lockie, MBBS, Severe Respiratory Failure Centre Department of Critical Care, Guy’s and St Thomas’ NHS Foundation Trust, Westminster Bridge Road, London, United Kingdom, SE1 7EH. E-mail:

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