Narrative Review of Neurologic Complications in Adults on ECMO: Prevalence, Risks, Outcomes, and Prevention Strategies.

Hongling Zhang,Xiaobo Yang,Jiqian Xu,Xiaojing Zou,Zhengdong Liu,You Shang,Huaqing Shu

doi:10.3389/fmed.2021.713333

Abstract

Extracorporeal membrane oxygenation (ECMO), a life-saving technique for patients with severe respiratory and cardiac diseases, is being increasingly utilized worldwide, particularly during the coronavirus disease 2019(COVID-19) pandemic, and there has been a sharp increase in the implementation of ECMO. However, due to the presence of various complications, the survival rate of patients undergoing ECMO remains low. Among the complications, the neurologic morbidity significantly associated with venoarterial and venovenous ECMO has received increasing attention. Generally, failure to recognize neurologic injury in time is reportedly associated with poor outcomes in patients on ECMO. Currently, multimodal monitoring is increasingly utilized in patients with devastating neurologic injuries and has been advocated as an important approach for early diagnosis. Here, we highlight the prevalence and outcomes, risk factors, current monitoring technologies, prevention, and treatment of neurologic complications in adult patients on ECMO. We believe that an improved understanding of neurologic complications presumably offers promising therapeutic solutions to prevent and treat neurologic morbidity.

Highlights

Extracorporeal membrane oxygenation (ECMO) is an increasingly utilized technique for patients with refractory respiratory and cardiac diseases
Because research regarding neurologic injury in hybrid ECMO modes is lacking, this paper focuses on neurologic complications in patients on VA and VV ECMO
Owing to meticulous anticoagulation therapy and frequent clinical neurologic assessment after prior detection, the above-mentioned study showed a considerable survival among patients on VV ECMO with intracranial hemorrhage (ICH) compared with many other reports [8, 10, 11]

Summary

Introduction

Extracorporeal membrane oxygenation (ECMO) is an increasingly utilized technique for patients with refractory respiratory and cardiac diseases. This article reviews the prevalence and outcomes, risk factors, and clinical strategies for neurologic complications in patients on ECMO. Owing to meticulous anticoagulation therapy and frequent clinical neurologic assessment after prior detection, the above-mentioned study showed a considerable survival among patients on VV ECMO with ICH compared with many other reports [8, 10, 11].

Results

Conclusion