Neurologic complications in patients receiving extracorporeal membrane oxygenation for influenza H1N1: Morbid but not futile

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Objectives: Extracorporeal membrane oxygenation (ECMO) is a well-established therapy for severe acute cardiac and respiratory distress. Management of complications, such as embolic strokes and intracranial hemorrhage, is essential during such treatment. However, the incidences of these complications as well as clinical outcomes have not been previously examined within a population with a homogenous disease process. Methods: Using de-identified clinical data submitted to the Extracorporeal Life Support Organization, we analyzed cases in which patients were treated with ECMO during the 2009 H1N1 pandemic. This data were examined with a specific focus on neurologic complications. Results: Twenty-two of the 248 patients experienced a confirmed neurological event. Patients with neurologic events were older, more acidotic, and had a higher prior incidence of cardiopulmonary arrest before ECMO therapy. There was also showed an increased incidence of cardiac arrhythmia, hyperbilirubinemia, and severe leukopenia as well as lower rates of successful weaning from ECMO and survival to discharge. Overall, within the patient population treated with ECMO, neurologic complications are not uncommon, and such patients exhibit greater morbidity and mortality. Conclusions: Thus, aggressive neurological assessment before and during ECMO could prove very useful in guiding clinical decisions with respect to further or ongoing therapies. The findings from this study will hopefully improve patient selection for ECMO therapy as well as clinical outcomes for this critically ill patient population. The following core competencies are addressed in this article: Patient care, Systems-based practice, Interpersonal skills and communication.