Neurological Complications of Veno-Arterial Extracorporeal Membrane Oxygenation: A Retrospective Case-Control Study

Abstract

Background: To explore the epidemiology, clinical features, risk indicators, and long-term outcomes of neurological complications caused by veno-arterial extracorporeal membrane oxygenation (V-A ECMO).Methods: We retrospectively analyzed 60 adult patients who underwent V-A ECMO support in our unit from February 2012 to August 2020. These patients were separated into the neurological complications group (NC group) and the non-neurological complications group (nNC group). The differences in basic data and ECMO data between the two groups were compared. The data of long-term neurological prognosis were collected by telephone follow-up.Results: Thirty-nine patients (65.0%) had neurological complications. There were significant differences between the two groups in terms of median age, hypertension, median blood urea nitrogen, median troponin I (TNI), median lactic acid, pre-ECMO percutaneous coronary intervention, continuous renal replacement therapy (CRRT), median Sequential Organ Failure Assessment score, median Acute Physiology and Chronic Health Evaluation II score, median peak inspiratory pressure, median positive end expiratory pressure, and median fresh frozen plasma (P < 0.05). The median Intensive Care Unit length of stay (ICU LOS), 28-day mortality, median post-ECMO vasoactive inotropic score, non-pulsate perfusion (NP), and median ECMO duration of the NC group were significantly higher than those of the nNC group (P < 0.05). Furthermore, multiple logistic regression analysis revealed that TNI (P = 0.043), CRRT (P = 0.047), and continuous NP > 12 h (P = 0.043) were independent risk indicators for neurological complications in patients undergoing ECMO. Forty-four patients (73.3%) survived after discharge, and 38 patients (63.3%) had Cerebral Performance Category score of 1–2. And there were significant differences between the two groups in long-term neurological outcomes after discharge for 6 months (P < 0.05).Conclusion: The incidence of neurological complications was higher in patients undergoing V-A ECMO and was closely related to adverse outcomes (including ICU LOS and 28-day mortality). TNI, CRRT, and continuous NP > 12 h were independent risk indicators for predicting neurological complications in ECMO supporting patients. And the neurological complications of patients during ECMO support had significant adverse effect on long-term surviving and neurological outcomes of patients after discharge for 6 months.

Early Changes in Arterial Partial Pressure of Carbon Dioxide and Blood Pressure After Starting Extracorporeal Membrane Oxygenation in Children: Extracorporeal Life Support Organization Database Study of Neurologic Complications*

“…We found that after controlling for a high initial Pa CO 2 , within the VV ECMO group, the early relative ΔCO 2 decrease was associated with neurologic complications. These findings have strong physiological basis as detailed previously, and similar relationships have been shown in smaller studies (19–26). Finally, within this pediatric cohort, mortality increased with those who had a relative ΔCO 2 decrease over 30%.…”

A Standardized Multimodal Neurological Monitoring Protocol-Guided Cerebral Protection Therapy for Venoarterial Extracorporeal Membrane Oxygenation Supported Patients

“…In our previous study, 65% of VA-ECMO-supported patients suffered neurological complications, and the identification of neurological complications mainly relied on subjective assessment methods such as GCS, CPC score, confusion assessment method for the ICU (CAM-ICU), and neuroimaging examination ( 11 ). To more accurately identify the neurological damage in ECMO-supported patients, we established the MNM-guided protocol, which is based on bedside noninvasive techniques such as qEEG, NIRS, and TCCD, combined with GCS and neurological examination, guiding clinicians to optimize the management of VA-ECMO patients.…”

“…We hope to conveniently monitor the resistance of cerebrovascular, cerebral blood flow velocity, and even whether there is cerebral vasospasm, cerebral edema, cerebral hemorrhage, brain midline shift, etc. We found that continuous non-pulsatile perfusion (NP) >12 h was an independent risk indicator for neurological complications in VA-ECMO-supported patients ( 11 ). TCCD is a noninvasive test that uses ultrasonography to estimate CBF.…”

“…Our previous study identified neurological impairment ( 11 ): temporal or persistent mental and physical features such as coma, delirium, depression, epilepsy, hypoxic-ischemic encephalopathy, ischemic stroke, cerebral hemorrhage, and death; and a GCS score <15 (patients with endotracheal intubation <11) or cerebral performance category score (CPC) ≥2 after eliminating the disturbance of sedation and analgesia.…”

Cerebral Neural Changes in Venous–Arterial Extracorporeal Membrane Oxygenation Survivors

“…Neurologic complications occur during or immediately after ECMO and are associated with poor survival [ 4 , 5 , 6 ]. Acute ischemic stroke, intracranial hemorrhage, seizures, cognitive decline, and brain death are a few of the short-term complications [ 7 ].…”