Abstract
Background/Objective: Extracorporeal membrane oxygenation (ECMO) is being increasingly used to provide cardiopulmonary support in critically ill patients. Up to 8% of patients on ECMO suffer from ischemic or hemorrhagic strokes. Additionally, cerebral microbleeds have been noted in ECMO patients, with unclear significance. We sought to characterize the prevalence, risk factors, and outcomes of patients with microbleeds after ECMO support at a single tertiary referral academic hospital with high volumes of ECMO patients. Methods: All patients receiving venovenous (vv) ECMO between January 2013 to December 2017 and all patients receiving venoarterial (va) ECMO between January 2015 to January 2018 at our hospital were retrospectively included in this study. Patient demographics, ECMO characteristics, confounding risk factors for bleed, , and patient outcomes were retrospectively extracted from the patient charts and correlated with the presence of cerebral microbleeds on brain MRI studies with Susceptibility Weighted Imaging (SWI) performed shortly after cessation of ECMO. Results: A total of 83 vv-ECMO patients and 224 va-ECMO patients were retrospectively reviewed. From this cohort, 45 patients (14 vv-ECMO, 31 va-ECMO) received brain MRI with SWI sequences. The median duration of ECMO in these patients was 4 days (range 1-25 days). The median time interval between ECMO placement and brain MRI acquisition was 12 days (range 3-744 days). Thirty eight of these 45 patients (84%) had cerebral microbleeds.. The majority of patients (77%) survived to discharge from the hospital. Conclusions: ECMO support, even brief durations, appears to be highly associated with cerebral microbleeds. The pattern of microbleeds in ECMO patients tends to occur in a distinct pattern, often localized to the corpus callosum. The mechanism of bleeding and long-term neurologic consequences of cerebral microbleeds secondary to ECMO microbleeds remains unclear. Further studies to elucidate any links between microbleeds and neurological sequelae of ECMO are needed.
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