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Abstract
BackgroundSingle- (SL) and double-lumen (DL) catheters are used in clinical practice for veno-venous extracorporeal membrane oxygenation (V-V ECMO) therapy. However, information is lacking regarding the effects of the cannulation on neurological complications.MethodsA retrospective observational study based on data from the Extracorporeal Life Support Organization (ELSO) registry. All adult patients included in the ELSO registry from 2011 to 2018 submitted to a single run of V-V ECMO were analyzed. Propensity score (PS) inverse probability of treatment weighting estimation for multiple treatments was used. The average treatment effect (ATE) was chosen as the causal effect estimate of outcome. The aim of the study was to evaluate differences in the occurrence and the type of neurological complications in adult patients undergoing V-V ECMO when treated with SL or DL cannulas.ResultsFrom a population of 6834 patients, the weighted propensity score matching included 6245 patients (i.e., 91% of the total cohort; 4175 with SL and 20,270 with DL cannulation). The proportion of patients with at least one neurological complication was similar in the SL (306, 7.2%) and DL (189, 7.7%; odds ratio 1.10 [95% confidence intervals 0.91–1.32]; p = 0.33). After weighted propensity score, the ATE for the occurrence of least one neurological complication was 0.005 (95% CI − 0.009 to 0.018; p = 0.50). Also, the occurrence of specific neurological complications, including intracerebral hemorrhage, acute ischemic stroke, seizures or brain death, was similar between groups. Overall mortality was similar between patients with neurological complications in the two groups.ConclusionsIn this large registry, the occurrence of neurological complications was not related to the type of cannulation in patients undergoing V-V ECMO.
Highlights
Veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) can be lifesaving in severe respiratory failure [1]
According to a recent retrospective cohort study from the Extracorporeal Life Support Organization (ELSO) Registry including 4,988 patients treated with V-V ECMO, 356 (7%) of them suffered from neurological complications, in particular intra-cranial hemorrhage (42.5%), stroke (19.9%), seizures (14.1%) and brain death (23.5%) [8]
We evaluated the occurrence and the type of neurologic complications in a large cohort of adult patients on V-V ECMO, according to the SL or DL cannulation
Summary
Veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) can be lifesaving in severe respiratory failure [1]. According to a recent retrospective cohort study from the Extracorporeal Life Support Organization (ELSO) Registry including 4,988 patients treated with V-V ECMO, 356 (7%) of them suffered from neurological complications, in particular intra-cranial hemorrhage (42.5%), stroke (19.9%), seizures (14.1%) and brain death (23.5%) [8]. Cerebral micro-emboli have been detected in patients undergoing both V-V and V-A ECMO and may play a role in the cerebrovascular injury [9] Another potential contributing factor to neurologic injury during V-V ECMO is cerebral venous congestion, which may be caused by large cannulas in the internal jugular veins or venous thrombosis [10, 11, 13]. Information is lacking regarding the effects of the cannulation on neurological complications
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