Neurologic Injury in Patients With COVID-19 Who Receive VV-ECMO Therapy: A Cohort Study

Kannapadi, Nivedha; Jami, Meghana; Premraj, Lavienraj; Etchill, Eric; Giuliano, Katherine; Bush, Errol L.; Kim, Bo Soo; Seal, Stella; Whitman, Glenn; Cho, Sung Min

doi:10.1053/j.jvca.2021.05.017

Cited by 6 publications

(8 citation statements)

References 18 publications

(14 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In a critically ill setting during the COVID-19 pandemic, new neurological complications occurred with high incidence and severity, which can be justified by the frequent need of life-sustaining therapies and the potential for multiple organ failure. Indeed, patients with COVID-19 who underwent extracorporeal membrane oxygenation manifested severe neurologic events in 25% of cases ( 47 ). Although the incidence and severity of neurological manifestations in patients with COVID-19 seemed to be predominant in the ICU setting, the literature confirmed that it was certainly crucial also in a non-critically ill setting.…”

Section: Discussionmentioning

confidence: 99%

Non-Invasive Multimodal Neuromonitoring in Non-Critically Ill Hospitalized Adult Patients With COVID-19: A Systematic Review and Meta-Analysis

et al. 2022

Self Cite

View full text Add to dashboard Cite

IntroductionNeurological complications are frequent in patients with coronavirus disease-2019 (COVID-19). The use of non-invasive neuromonitoring in subjects without primary brain injury but with potential neurological derangement is gaining attention outside the intensive care unit (ICU). This systematic review and meta-analysis investigates the use of non-invasive multimodal neuromonitoring of the brain in non-critically ill patients with COVID-19 outside the ICU and quantifies the prevalence of abnormal neuromonitoring findings in this population.MethodsA structured literature search was performed in MEDLINE/PubMed, Scopus, Cochrane, and EMBASE to investigate the use of non-invasive neuromonitoring tools, including transcranial doppler (TCD); optic nerve sheath diameter (ONSD); near-infrared spectroscopy (NIRS); pupillometry; and electroencephalography (EEG) inpatients with COVID-19 outside the ICU. The proportion of non-ICU patients with CVOID-19 and a particular neurological feature at neuromonitoring at the study time was defined as prevalence.ResultsA total of 6,593 records were identified through literature searching. Twenty-one studies were finally selected, comprising 368 non-ICU patients, of whom 97 were considered for the prevalence of meta-analysis. The pooled prevalence of electroencephalographic seizures, periodic and rhythmic patterns, slow background abnormalities, and abnormal background on EEG was.17 (95% CI 0.04–0.29), 0.42 (95% CI 0.01–0.82), 0.92 (95% CI 0.83–1.01), and.95 (95% CI 0.088–1.09), respectively. No studies investigating NIRS and ONSD outside the ICU were found. The pooled prevalence for abnormal neuromonitoring findings detected using the TCD and pupillometry were incomputable due to insufficient data.ConclusionsNeuromonitoring tools are non-invasive, less expensive, safe, and bedside available tools with a great potential for both diagnosis and monitoring of patients with COVID-19 at risk of brain derangements. However, extensive literature searching reveals that they are rarely used outside critical care settings.Systematic Review Registration:www.crd.york.ac.uk/prospero/display_record.php?RecordID=265617, identifier: CRD42021265617.

show abstract

Section: Discussionmentioning

confidence: 99%

Non-Invasive Multimodal Neuromonitoring in Non-Critically Ill Hospitalized Adult Patients With COVID-19: A Systematic Review and Meta-Analysis

et al. 2022

Self Cite

View full text Add to dashboard Cite

show abstract

“…22 This presence of neurologic injury was associated with an increased risk of mortality from ECMO. 38 ECMO may be beneficial for these patients, especially in the presence of active inflammation. 22 Coronavirus disease 2019 could increase the risk of thromboembolic events due to hypoxia, excessive inflammation, platelet activation, endothelial dysfunction, and stasis.…”

Section: Discussionmentioning

confidence: 99%

“…Thirty-day mortality after ECMO implantation was reported in seven studies involving a total of 335 patients. 25,35,38,53,55,58,59 It varied from 18.8% to 63.0%, and the pooled 30-day mortality was 46% (95% CI 37%-57%, I 2 = 66%; Figure 2(a)). Four studies, involving 276 COVID-19 patients managed with ECMO, reported on 60-day mortality that varied from 13.3% to 80.8%.…”

Section: Primary Outcomementioning

confidence: 99%

“…There were 18 studies reporting the events of major bleeding in COVID-19 patients who received ECMO support, 19,20,22,[27][28][29][37][38][39]43,46,49,50,52,[56][57][58]60 and the incidence of hemorrhage varied from 3.7% to 81.3%. Meta-analysis of proportions found that the pooled incidence rate of bleeding requiring transfusion was 39% (95% CI 28%-52%, I 2 = 76%; Figure 4) in ECMOassisted patients with COVID-19.…”

Section: Bleeding Eventsmentioning

confidence: 99%

“…Total 17 studies reported the incidence of hemorrhagic stroke events in an overall hospital setting, varying from 0% to 41.7%. 20,25,29,[31][32][33][37][38][39]44,46,50,52,[56][57][58]60 The events were observed in 58 out of 527 COVID-19 patients treated with ECMO in hospital. Meta-analysis of proportions revealed a pooled incidence rate of hemorrhagic stroke was 11% (95% CI 9%-14%, I 2 = 42%; Figure 5) in hospitalized COVID-19 patients.…”

Section: Hemorrhagic Strokementioning

confidence: 99%

See 2 more Smart Citations

Venovenous extracorporeal membrane oxygenation for coronavirus disease 2019 patients: A systematic review and meta-analysis

Zhai

Zhang

et al. 2022

Perfusion

View full text Add to dashboard Cite

Objective Although the application of venovenous extracorporeal membrane oxygenation (VV-ECMO) in coronavirus disease 2019 (COVID-19) patients with acute respiratory distress syndrome (ARDS) is accumulating, the feasibility and safety of this therapy remain controversial. We aimed to evaluate the effect of VV-ECMO in the treatment of these patients. Methods A comprehensive literature search was performed using PubMed, Embase, the Cochrane Library, and International Clinical Trials Registry Platform databases through November 2021. According to the inclusion and exclusion criteria, the included studies were screened, and meta-analysis was performed by R software (version 4.0.2). Results Forty-two studies including 2037 COVID-19 patients supported with VV-ECMO due to ARDS were identified. The pooled analysis revealed that 30-, 60-, and 90-day mortality among patients were respectively 46% (95% CI 37%–57%, I2 = 66%), 46% (95% CI 30%–70%, I2 = 93%), and 49% (95% CI 43%–58%, I2 = 52%), and the pooled incidence rate of in-hospital mortality, major bleeding, hemorrhagic stroke, thrombosis, pulmonary embolism, deep venous thrombosis, and renal replacement therapy were respectively 35%, 39%, 11%, 40%, 15%, 21%, and 44%. Conclusion Although COVID-19 patients may have a higher risk of bleeding, hemorrhagic stroke, and acute kidney injury during ECMO therapy, the survival rate was more than half of the cases. Our data may support the application of VV-ECMO in COVID-19 patients.

show abstract

Cerebral protection and management during extracorporeal membrane oxygenation

Belliato¹,

Veronesi²,

Pellegrini³

2023

Cardiopulmonary Bypass

View full text Add to dashboard Cite

Neurologic Injury in Patients With COVID-19 Who Receive VV-ECMO Therapy: A Cohort Study

Cited by 6 publications

References 18 publications

Non-Invasive Multimodal Neuromonitoring in Non-Critically Ill Hospitalized Adult Patients With COVID-19: A Systematic Review and Meta-Analysis

Non-Invasive Multimodal Neuromonitoring in Non-Critically Ill Hospitalized Adult Patients With COVID-19: A Systematic Review and Meta-Analysis

Venovenous extracorporeal membrane oxygenation for coronavirus disease 2019 patients: A systematic review and meta-analysis

Cerebral protection and management during extracorporeal membrane oxygenation

Contact Info

Product

Resources

About