Neurological Complications of Veno-Arterial Extracorporeal Membrane Oxygenation: A Retrospective Case-Control Study.

Yinan Luo,Qiao Gu,Ying Zhu,Shaosong Xi,Xin Wen,Yiwei Li,Wei Hu,Weihua Peng

doi:10.3389/fmed.2021.698242

Abstract

Background: To explore the epidemiology, clinical features, risk indicators, and long-term outcomes of neurological complications caused by veno-arterial extracorporeal membrane oxygenation (V-A ECMO).Methods: We retrospectively analyzed 60 adult patients who underwent V-A ECMO support in our unit from February 2012 to August 2020. These patients were separated into the neurological complications group (NC group) and the non-neurological complications group (nNC group). The differences in basic data and ECMO data between the two groups were compared. The data of long-term neurological prognosis were collected by telephone follow-up.Results: Thirty-nine patients (65.0%) had neurological complications. There were significant differences between the two groups in terms of median age, hypertension, median blood urea nitrogen, median troponin I (TNI), median lactic acid, pre-ECMO percutaneous coronary intervention, continuous renal replacement therapy (CRRT), median Sequential Organ Failure Assessment score, median Acute Physiology and Chronic Health Evaluation II score, median peak inspiratory pressure, median positive end expiratory pressure, and median fresh frozen plasma (P < 0.05). The median Intensive Care Unit length of stay (ICU LOS), 28-day mortality, median post-ECMO vasoactive inotropic score, non-pulsate perfusion (NP), and median ECMO duration of the NC group were significantly higher than those of the nNC group (P < 0.05). Furthermore, multiple logistic regression analysis revealed that TNI (P = 0.043), CRRT (P = 0.047), and continuous NP > 12 h (P = 0.043) were independent risk indicators for neurological complications in patients undergoing ECMO. Forty-four patients (73.3%) survived after discharge, and 38 patients (63.3%) had Cerebral Performance Category score of 1–2. And there were significant differences between the two groups in long-term neurological outcomes after discharge for 6 months (P < 0.05).Conclusion: The incidence of neurological complications was higher in patients undergoing V-A ECMO and was closely related to adverse outcomes (including ICU LOS and 28-day mortality). TNI, CRRT, and continuous NP > 12 h were independent risk indicators for predicting neurological complications in ECMO supporting patients. And the neurological complications of patients during ECMO support had significant adverse effect on long-term surviving and neurological outcomes of patients after discharge for 6 months.

Highlights

Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) can replace the roles of the heart and lungs to maintain circulation and respiration and is used to treat acute cardiac or pulmonary failure
(1) Baseline characteristics: Age; sex; underlying diseases, including hypertension, diabetes, and coronary heart disease (CHD); etiology supporting the use of ECMO; hemodynamic data such as mean arterial pressure (MAP) and Central Venous Pressure (CVP); biochemical indexes 24 h post-ECMO support; assessment of severity after ECMO support for 24 h, including Acute Physiology and Chronic Health Evaluation II (APACHE-II) score, Sequential Organ Failure Assessment (SOFA) score; and other interventions, including percutaneous coronary intervention (PCI), intra-aortic balloon pump (IABP), mechanical ventilation (MV), and continuous renal replacement therapy (CRRT)
We found significant differences 24 h postECMO support between the NC and nNC groups with respect to the median concentration of blood urea nitrogen (BUN) (8.12 [605, 13.81] vs. 6.43 [4.45, 8.71] mmol/L, P = 0.012), median concentration of troponin I (TNI) (16.7 [1.7, 88.8] vs. 5.0 [1.5, 7.5] μg/L, P = 0.041), median concentration of

Summary

Introduction

Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) can replace the roles of the heart and lungs to maintain circulation and respiration and is used to treat acute cardiac or pulmonary failure. ECMO support can cause various complications due to the severity of the diseases and longstanding extracorporeal circulation, which may negatively impact patients’ survival (1, 2). Mortality and poor functional outcomes are often induced by neurological injury that results from underlying diseases and from complications associated with ECMO support itself (4, 5). The data about epidemiology, pathophysiology, and risk indicators of neurological complications is limited, no practice guidelines or management strategies for the neurological care of ECMO patients (9, 10). Clinical features, risk indicators, and long-term outcomes of neurological complications caused by veno-arterial extracorporeal membrane oxygenation (V-A ECMO)

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