Abstract 241: Neurologic Complications Associated With Extracorporeal Cardiopulmonary Resuscitation for In-Hospital Cardiac Arrest

Abstract

Background: Neurologic complications are frequently encountered after ECPR and there is a limited understanding of the associated clinical trajectories following ECPR for in-hospital cardiac arrest (IHCA). Aim: To determine the prevalence, properties, and outcomes of radiographic neurologic complications following ECPR for IHCA. Methods: In this single-center retrospective chart review, we collected data on all adult IHCA patients who underwent ECPR from 1/1/2018 to 12/31/2019. Measured variables included demographics, clinical data, timing of diagnostic studies, and outcomes. Results: Data were analyzed from 36 adult ECPR patients, 16 (44%) of whom survived to hospital discharge. Twenty (56%) underwent head computed tomography (CT) and 9 (25%) had pathology identified, diagnosed a median of 1.8 days afterECPR. The most common complications were intracranial hemorrhage and focal ischemia (4/9 patients each). Neurologic complications were not associated with total ECMO duration (median 4 vs 5 days, p=0.57) and patients with complications trended toward poorer survival outcomes (22% vs 52% survival to discharge; p=0.25). Conclusions: Radiographic neurologic complications occurred in one quarter of IHCA ECPR patients and were associated with trends towards poorer clinical outcomes. Consistent with data in the non-ECPR literature, rates of global anoxic injury and hospital mortality were lower in this IHCA cohort than in previously published OHCA and mixed ECPR cohorts. This study is limited by its small sample size, single center design, and lack of a standardized neuroimaging protocol. Future prospective studies are needed to assess the efficacy of ECPR for IHCA.