Incidence and Outcome of Neurological Complications in Veno-Arterial Extracorporeal Membrane Oxygenation Support for Cardiogenic Shock

Abstract

Purpose Neurological complications (NC) are potentially devastating for cardiogenic shock patients receiving veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support. The purpose of this study was to investigate the overall incidence and pattern of NC and their impact on outcome. Methods We retrospectively reviewed 498 consecutive patients who received VA-ECMO support for cardiogenic shock between March 2007 and May 2018. Information on NC type, including stroke, altered mental status, seizure, encephalopathy, and transient ischemic attack and other neurological events was collected. Survival to discharge was compared between patients with and without neurological complications. Results Median age of the entire cohort was 60 years (IQR 49-68), and 69% were male. Etiology of cardiogenic shock included post-cardiotomy shock (n=154, 33%), acute myocardial infarction (n=124, 27%), post-transplant graft failure (n=60, 13%), acute decompensated heart failure (n=65, 14%), and others (n=57, 12%). Eighty-seven patients were cannulated via the ascending aorta (18%), 37 via the axillary artery (7%), and 374 (75%) via the femoral artery. In total, 125 patients (25%) were diagnosed with NC: altered mental status was most common n=62 (12%), stroke n=29 (6%), encephalopathy n=16 (3%), seizure n=15 (3%), transient ischemic attack/others n=16 (3%). NC diagnosis was significantly associated with higher in-hospital mortality rates (74%, n=93) vs. non-NC diagnosis (61%, n=229), (p=0.008). Among NC subtypes, encephalopathy had the highest in-hospital mortality rate (94%, n=15), followed by stroke (72%, n=21) and AMS (71%, n=44). Conclusion Neurological disorders are common in cardiogenic shock patients who receive VA-ECMO and significantly impact in-hospital mortality rates.