Neurologic Complications in Adult Post-cardiotomy Cardiogenic Shock Patients Receiving Venoarterial Extracorporeal Membrane Oxygenation: A Cohort Study.

Dengbang Hou,Xiaotong Hou,Hong Wang,Feng Yang

doi:10.3389/fmed.2021.721774

Dengbang Hou, Xiaotong Hou + Show 2 more

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https://doi.org/10.3389/fmed.2021.721774

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Abstract

Background: This study aims to describe the prevalence of neurologic complications and hospital outcome in adult post-cardiotomy cardiogenic shock (PCS) patients receiving veno-arterial extracorporeal membrane oxygenation (V-A ECMO) support and factors associated with such adverse events.Methods: Four hundred and fifteen adult patients underwent cardiac surgery and received V-A ECMO for more than 24 h because of PCS. Patients were divided into two groups: those who developed a neurological complication and those who did not (control group). Multivariable logistic regression was performed to identify factors independently associated with neurologic complications.Results: Neurologic complications occurred in 87 patients (21.0%), including cerebral infarction in 33 patients (8.0%), brain death in 30 patients (7.2%), seizures in 14 patients (3.4%), and intracranial hemorrhage in 11 (2.7%) patients. In-hospital mortality in patients with neurologic complications was 90.8%, compared to 52.1% in control patients (p < 0.001). In a multivariable model, the lowest systolic blood pressure (SBP) level pre-ECMO (OR, 0.89; 95% CI: 0.86–0.93) and aortic surgery combined with coronary artery bypass grafting (OR, 9.22; 95% CI: 2.10–40.55) were associated with overall neurologic complications. Age (OR, 1.06; 95% CI: 1.01–1.12) and lowest SBP (OR, 0.81; 95% CI: 0.76–0.87) were correlative factors of brain death. Coagulation disorders (OR, 9.75; 95% CI: 1.83–51.89) and atrial fibrillation (OR, 12.19; 95% CI: 1.22–121.61) were shown to be associated independently with intracranial hemorrhage, whereas atrial fibrillation (OR, 8.15; 95% CI: 1.31–50.62) was also associated with cerebral infarction.Conclusions: Neurologic complications in adult PCS patients undergoing V-A ECMO support are frequent and associated with higher in-hospital mortality. Identified risk factors of neurologic complications might help to improve ECMO management and might reduce their occurrence.

Highlights

Veno-arterial extracorporeal membrane oxygenation (V-A veno-arterial extracorporeal membrane oxygenation (ECMO)) is an effective technique to rescue patients with refractory cardiogenic shock or cardiac arrest [1,2,3,4]
Data were extracted from the Abbreviations: ACT, activated clotting time; aPTT, activated partial thromboplastin time; BMI, body mass index; CABG, coronary artery bypass grafting; CI, confidence interval; CNS, central nervous system; COPD, chronic obstructive pulmonary disease; CPB, cardiopulmonary bypass; CPR, cardiopulmonary resuscitation; CRRT, continuous renal replacement therapy; CT, computed tomography; ECMO, extracorporeal membrane oxygenation; ECPR, extracorporeal cardiopulmonary resuscitation; FFP, fresh frozen plasma; IABP, intra-aortic balloon pump; ICU, intensive care unit; IQR, interquartile range; LCOS, low cardiac output syndrome; MV, mechanical ventilation; OR, odds ratio; PCS, post-cardiotomy cardiogenic shock; RBC, red blood cells; SBP, systolic blood pressure; VA ECMO, veno-arterial extracorporeal membrane oxygenation
ECMO implantation Failure to wean off CPB LCOS in ICU ECPR Transfusion RBC (U) FFP Complications Renal failure need CRRT Lower extremities ischemia Femoral artery embolism Cannulate site hemorrhage Retroperitoneal hematoma Major bleeding of other reasons Surgical incision infection Sepsis Lower phlebothrombosis Re-thoracotomy for hemostasis Tracheostomy Outcomes Weaning from ECMO Duration of ECMO (h) Survival to discharge Duration of MV (h) ICU length of stay (h) Hospital stay (d)

Summary

Introduction

Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is an effective technique to rescue patients with refractory cardiogenic shock or cardiac arrest [1,2,3,4]. The patients enrolled in these studies were from the Extracorporeal Life Support Organization (ELSO) registry or the complication profiles of detailed V-A ECMO indications were well not well-defined or including various V-A ECMO settings [9,10,11,12,13]. This study aims to describe the prevalence of neurologic complications and hospital outcome in adult post-cardiotomy cardiogenic shock (PCS) patients receiving veno-arterial extracorporeal membrane oxygenation (V-A ECMO) support and factors associated with such adverse events

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