Neurologic Complications of Extracorporeal Membrane Oxygenation

Abstract

Background and PurposeThe rate and outcomes of neurologic complications of patients receiving extracorporeal membrane oxygenation (ECMO) are poorly understood. The purpose of this study was to identify these parameters in ECMO patients.MethodsAll patients receiving ECMO were selected from the Nationwide Inpatient Sample between 2001-2011. The rate and outcomes of neurologic complications [acute ischemic stroke, intracranial hemorrhage (ICH), and seizures] among these patients was determined. Discharge status, mortality, length of stay, and hospitalization costs were compared between patients with and without neurologic complications using chi-squared tests for categorical variables and Student's t-test for continuous variables.ResultsIn total, 23,951 patients were included in this study, of which 2,604 (10.9%) suffered neurologic complications of seizure (4.1%), stroke (4.1%), or ICH (3.6%). When compared to patients without neurologic complications, acute ischemic stroke patients had significantly higher rates of discharge to a long-term facility (12.2% vs. 6.8%, p<0.0001) and a significantly longer mean length of stay (41.6 days vs. 31.9 days, p<0.0001). ICH patients had significantly higher rates of discharge to a long-term facility (9.5% vs. 6.8%, p=0.007), significantly higher mortality rates (59.7% vs. 50.0%, p<0.0001), and a significantly longer mean length of stay (41.8 days vs. 31.9 days) compared to patients without neurologic complications. These outcomes did not differ significantly between seizure patients and patients without neurologic complications.ConclusionsGiven the increasing utilization of ECMO and the high costs and poor outcomes associated with neurologic complications, more research is needed to help determine the best way to prevent these sequelae in this patient population.

Brain injury during venovenous extracorporeal membrane oxygenation

“…The authors of the largest study that included 23,951 patients given ECMO support reported 10.9% neurological complications [13]. Ischemic stroke, cerebral bleeding and seizure frequencies were 4.1%, 3.6% and 4.1%, respectively, but, as underlined by the authors themselves, they mixed adults, children and newborns, and were unable to distinguish patients receiving VV-and/or VA-ECMO [13]. The cerebral bleeding frequency for VV-ECMO patients observed in the systematic review (see online supplement) was 5%, similar to ours.…”

Neurologic Complications and Neuromonitoring on ECMO

“…An analysis of the ELSO registry for adult patients on VA ECMO, by the same group, found similar findings in the venoarterial cohort [9]. A decade's review of the Nationwide Inpatient Sample, that included over 23,000 patients, found that adult patients with acute ischemic stroke and intracranial hemorrhage on ECMO had higher rates of discharge to a long term facility and longer length of stay when compared to patients without neurologic injury [10].…”

Hematologic concerns in extracorporeal membrane oxygenation

“…Other risks associated with VA ECMO vary among patient populations, indications, and cannulation technique. Complications include hemorrhage in 30%‐70% of patients, stroke in 4%‐12% , limb ischemia in 12%‐22%, and left ventricular distention, which both delays separation from ECMO and increases areas of stasis and hematologic complications 1‐7 . Assessing the true risk of complications associated with ECMO is difficult because of the differences in populations, indications (including cardiac arrest, low cardiac output, and respiratory failure), cannulation techniques, circuitry, and anticoagulation strategies.…”