Neurologic Injury With Severe Adult Respiratory Distress Syndrome in Patients Undergoing Extracorporeal Membrane Oxygenation: A Single-Center Retrospective Analysis

Klinzing, Stephanie; Wenger, Urs; Stretti, Federica; Steiger, Peter; Schwarz, Urs; Maggiorini, Marco

doi:10.1213/ane.0000000000002431

Cited by 18 publications

(12 citation statements)

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“…While many studies on ICH predictors combined ischemic and hemorrhagic stroke in outcome models ( 15 , 17 , 18 , 20 ), four studies analyzed predictors of solely ICH in adult ECMO patients ( 13 , 14 , 19 , 20 ). They found that an increased risk of ICH was associated with ECMO-duration ( 20 ), pre- and per-ECMO antithrombotic therapy (defined as antithrombotic therapy administered prior to, or during, ECMO treatment) ( 13 , 14 ), altered intrinsic coagulation ( 13 , 14 , 20 ), renal failure ( 19 ), and even pre-ECMO morbidity ( 13 ), to name a few.…”

Section: Resultsmentioning

confidence: 99%

“…The reported incidence of ICH in adults during ECMO varied between 1.8 and 21 % ( 4 , 5 , 13 – 22 ) (Table 1 ). It is important to note that sedatives and muscle relaxants used during ECMO can mask symptoms of brain injury, resulting in the fact that several ECMO-associated ICH diagnoses are made in the absence of neurological symptoms ( 15 , 23 , 27 ). Moreover, while a CT scan is the gold standard to detect an ICH, in some cases ICH was only detected on magnetic resonance imaging (MRI) ( 28 , 29 ) or post-mortem autopsies ( 24 , 30 ).…”

Section: Discussionmentioning

confidence: 99%

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Incidence, Outcome, and Predictors of Intracranial Hemorrhage in Adult Patients on Extracorporeal Membrane Oxygenation: A Systematic and Narrative Review

et al. 2018

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Background: Intracranial hemorrhage (ICH) is a common complication in adults treated with extracorporeal membrane oxygenation (ECMO).Objectives: The aim of this study was to conduct a systematic review of the literature on the incidence, outcome and predictors of ECMO-associated ICH in adult patients, supplemented by a narrative review of its pathophysiology, management and future perspectives.Methods: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews and www.clinicaltrials.gov were systematically searched. Studies that reported incidence, outcome or predictors of ECMO-associated ICH in adults (≥18 years) were eligible for inclusion.Results: Twenty five articles were included in the systematic review. The incidence of ECMO-associated ICH varied between 1.8 and 21 %. Mortality rates in ICH-cohorts varied between 32 and 100 %, with a relative risk of mortality of 1.27–4.43 compared to non-ICH cohorts. An increased risk of ICH was associated with ECMO-duration, antithrombotic therapy, altered intrinsic coagulation, renal failure, need of blood products, rapid hypercapnia at ECMO initiation, and even pre-ECMO morbidity.Conclusions: ICH is a common complication in adults treated with ECMO and associated with increased mortality. Treating an ICH during ECMO represents a balance between pro- and anticoagulatory demands. Neurosurgical treatment is associated with severe morbidity, but has been successful in selected cases. Future studies should aim at investigating the validity and feasibility of non-invasive monitoring in early detection of ECMO-associated ICH.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Incidence, Outcome, and Predictors of Intracranial Hemorrhage in Adult Patients on Extracorporeal Membrane Oxygenation: A Systematic and Narrative Review

et al. 2018

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“…In addition, although the multicenter international extracorporeal life support organization (ELSO) registry and another multicenter database comprise the data of more than 8000 patients, the characteristics and subtypes of intracranial bleedings are neither considered nor reported in detail [18,22]. So far, data differentiating subtypes of intracranial bleedings are all derived from a few retrospective single-center studies [9,15,17]. In these studies, the incidence of intracranial bleeding differed between 16.4 and 21.3%, with ICH being the most frequent intracranial bleeding type.…”

Section: Discussionmentioning

confidence: 99%

Clinical management and outcome of adult patients with extracorporeal life support device–associated intracerebral hemorrhage—a neurocritical perspective and grading

et al. 2021

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Intracerebral hemorrhage (ICH) is a devastating complication in patients treated with extracorporeal membrane oxygenation (ECMO) due to respiratory or cardiac issues. Neurosurgical evaluation and management of such cases has only insufficiently been studied. We conducted a retrospective, cohort study of adult patients treated with ECMO between January 2007 and January 2017 in a tertiary healthcare center. Demographics, clinical data, coagulation status, ICH characteristics, and treatment modalities were analyzed. The primary outcome parameter was defined as mortality caused by ICH during ECMO. 525 patients with ECMO therapy were eligible for analysis. An overall incidence for any type of intracranial bleeding of 12.3% was found. Small hemorrhages accounted for 6.4% and acute subdural and epidural hematoma for 1.2%. Twenty-four (4.6%) patients developed ICH, and 11 patients (46%) died due to the ICH. Mortality was significantly higher in patients with larger ICH volumes (86.8 ± 34.8 ml vs 9.9 ± 20.3 ml, p < 0.001), intraventricular hemorrhage (83% vs 8%, p = 0.01), and a fluid level inside the ICH (75% vs 31%, p = 0.04). All patients were classified according to the bleeding pattern on the initial CT scan into 3 types. Patients with type 1 bleeding were statistically more likely to die (p < 0.001). In 15 out of 24 patients (63%), correction of the coagulation status was possible within 12 h after ICH onset. Seven out of 9 patients (78%) without early coagulation correction died compared to 2 out of 15 patients (13%), in whom early coagulation correction was successful (p = 0.01). This is the first study evaluating the course and management of patients experiencing an ICH under ECMO therapy and establishing an ICH classification based on the bleeding patterns. Early correction of the coagulation is of paramount importance in the treatment of these patients.

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“…Previous studies have focused on one complication at a time (nosocomial infection, thromboembolic event, bleeding, transfusion, etc.) and on the relationship between this specific complication and death [ 1 – 3 , 8 , 9 , 23 , 24 ]. Our study used a large cohort and a methodology that allowed us to highlight: i ) complications that cluster together and cluster close to death; and ii ) four patterns of patients according to complications, including one with no complications.…”

Section: Discussionmentioning

confidence: 99%

Complication patterns in patients undergoing venoarterial extracorporeal membrane oxygenation in intensive care unit: Multiple correspondence analysis and hierarchical ascendant classification

et al. 2018

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BackgroundTreatment by venoarterial extracorporeal membrane oxygenation (VA-ECMO) is widely used today, even though it is associated with high risks of complications and death. While studies have focused on the relationship between some of these complications and the risk of death, the relationship between different complications has never been specifically examined, despite the fact that the occurrence of one complication is known to favor the occurrence of others. Our objective was to describe the relationship between complications in patients undergoing VA-ECMO in intensive care unit (ICU) and to identify, if possible, patterns of patients according to complications.Methods and findingsAs part of a retrospective cohort study, we conducted a multiple correspondence analysis followed by a hierarchical ascendant classification in order to identify patterns of patients according to main complications (sepsis, thromboembolic event, major transfusion, major bleeding, renal replacement therapy) and in-ICU death. Our cohort of 145 patients presented an in-ICU mortality rate of 50.3%. Morbidity was high, with 36.5% of patients presenting three or more of the five complications studied. Multiple correspondence analysis revealed a cumulative inertia of 76.9% for the first three dimensions. Complications were clustered together and clustered close to death, prompting the identification of four patterns of patients according to complications, including one with no complications.ConclusionsOur study, based on a large cohort of patients undergoing VA-ECMO in ICU and presenting a mortality rate comparable to that reported in the literature, identified numerous and often interrelated complications. Multiple correspondence analysis and hierarchical ascendant classification yielded clusters of patients and highlighted specific links between some of the complications studied. Further research should be conducted in this area.

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Neurologic Injury With Severe Adult Respiratory Distress Syndrome in Patients Undergoing Extracorporeal Membrane Oxygenation: A Single-Center Retrospective Analysis

Cited by 18 publications

References 10 publications

Incidence, Outcome, and Predictors of Intracranial Hemorrhage in Adult Patients on Extracorporeal Membrane Oxygenation: A Systematic and Narrative Review

Incidence, Outcome, and Predictors of Intracranial Hemorrhage in Adult Patients on Extracorporeal Membrane Oxygenation: A Systematic and Narrative Review

Clinical management and outcome of adult patients with extracorporeal life support device–associated intracerebral hemorrhage—a neurocritical perspective and grading

Complication patterns in patients undergoing venoarterial extracorporeal membrane oxygenation in intensive care unit: Multiple correspondence analysis and hierarchical ascendant classification

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