Abstract
Extracorporeal membrane oxygenation (ECMO) is potentially lifesaving for patients with acute respiratory distress syndrome (ARDS) but may be accompanied by serious adverse events, including intracranial hemorrhage (ICRH). We hypothesized that ICRH occurs more frequently in patients with COVID-19 than in patients with ARDS of other etiologies. We performed a single-center retrospective analysis of adult patients treated with venovenous (vv-) ECMO for ARDS between January 2011 and April 2021. Patients were included if they had received a cranial computed tomography (cCT) scan during vv-ECMO support or within 72 h after ECMO removal. Cox regression analysis was used to identify factors associated with ICRH. During the study period, we identified 204 patients with vv-ECMO for ARDS, for whom a cCT scan was available. We observed ICRH in 35.4% (n = 17/48) of patients with COVID-19 and in 16.7% (n = 26/156) of patients with ARDS attributable to factors other than COVID-19. COVID-19 (HR: 2.945; 95%; CI: 1.079–8.038; p = 0.035) and carboxyhemoglobin (HR: 0.330; 95%; CI: 0.135–0.806; p = 0.015) were associated with ICRH during vv-ECMO. In patients receiving vv-ECMO, the incidence of ICRH is doubled in patients with COVID-19 compared to patients suffering from ARDS attributable to other causes. More studies on the association between COVID-19 and ICRH during vv-ECMO are urgently needed to identify risk patterns and targets for potential therapeutic interventions.
Highlights
Introduction distributed under the terms andThe number of patients presenting with acute respiratory distress syndrome (ARDS)has increased substantially since the novel severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) has spread worldwide and caused the ongoing COVID-19 pandemic [1]
Throughout the study period, high-flow vv-extracorporeal membrane oxygenation (ECMO) systems were used in a total number of 402 patients with acute respiratory failure
One hundred and fifty-six patients suffered from non-COVID-19-associated ARDS and received vv-ECMO support from January 2011 to April 2021 (Table 1). Another 48 patients were diagnosed with COVID-19-associated ARDS and had vv-ECMO therapy from March
Summary
The number of patients presenting with acute respiratory distress syndrome (ARDS). Has increased substantially since the novel severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) has spread worldwide and caused the ongoing COVID-19 pandemic [1]. Current guidelines recommend venovenous ECMO (vv-ECMO) in ARDS patients with hypoxemia or impaired decarboxylation refractory to supportive care, including but not limited to mechanical ventilation, prone positioning, and restrictive fluid management [3]. ECMO should be considered in COVID-19-associated ARDS with hypoxemia or hypercapnia not responding to adjunctive treatment [2,4]. Providing lifesaving pulmonary support, ECMO-related complications may be associated with fatal outcomes [5,6,7]. Studies of intracranial adverse events associated with ECMO therapy from the pre-COVID-19 era are manifold. Intracranial hemorrhage (ICRH) represents the most devastating complication, with a reported incidence of 3.1% to 12.3%, leading to a mortality rate as high as 73% [5,8,9,10]
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