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Neurologic Injury in Patients Treated With Extracorporeal Membrane Oxygenation for Postcardiotomy Cardiogenic Shock

Toivonen, Fanni LU ; Biancari, Fausto ; Dalén, Magnus ; Dell'Aquila, Angelo M. ; Jónsson, Kristján ; Fiore, Antonio ; Mariscalco, Giovanni ; El-Dean, Zein ; Gatti, Giuseppe and Zipfel, Svante , et al. (2021) In Journal of Cardiothoracic and Vascular Anesthesia 35(9). p.2669-2680
Abstract

Objective: To investigate the frequency, predictors, and outcomes of neurologic injury in adults treated with postcardiotomy extracorporeal membrane oxygenation (PC-ECMO). Design: A retrospective multicenter registry study. Setting: Twenty-one European institutions where cardiac surgery is performed. Participants: A total of 781 adult patients who required PC-ECMO during 2010 to 2018 were divided into patients with neurologic injury (NI) and patients without neurologic injury (NNI). Measurements and Main Results: Baseline and operative data, in-hospital outcomes, and long-term survival were compared between the NI and the NNI groups. Predictors of neurologic injury were identified. A subgroup analysis according to the type of neurologic... (More)

Objective: To investigate the frequency, predictors, and outcomes of neurologic injury in adults treated with postcardiotomy extracorporeal membrane oxygenation (PC-ECMO). Design: A retrospective multicenter registry study. Setting: Twenty-one European institutions where cardiac surgery is performed. Participants: A total of 781 adult patients who required PC-ECMO during 2010 to 2018 were divided into patients with neurologic injury (NI) and patients without neurologic injury (NNI). Measurements and Main Results: Baseline and operative data, in-hospital outcomes, and long-term survival were compared between the NI and the NNI groups. Predictors of neurologic injury were identified. A subgroup analysis according to the type of neurologic injury was performed. Overall, NI occurred in 19% of patients in the overall series, but the proportion of patients with NI ranged from 0% to 65% among the centers. Ischemic stroke occurred in 84 patients and hemorrhagic stroke in 47 patients. Emergency procedure was the sole independent predictor of NI. In-hospital mortality was higher in the NI group than in the NNI group (79% v 61%, p < 0.001). The one-year survival was lower in the NI group (17%) compared with the NNI group (37%). Long-term survival did not differ between patients with ischemic stroke and those with hemorrhagic stroke. Conclusion: Neurologic injury during PC-ECMO is common and associated with a dismal prognosis. There is considerable interinstitutional variation in the proportion of neurologic injury in PC-ECMO-treated adults. Well-known risk factors for stroke are not associated with neurologic injury in this setting.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
extracorporeal membrane oxygenation, intracerebral hemorrhage, ischemic stroke, neurologic injury, outcome, postcardiotomy shock, stroke
in
Journal of Cardiothoracic and Vascular Anesthesia
volume
35
issue
9
pages
12 pages
publisher
Elsevier
external identifiers
  • scopus:85097045500
  • pmid:33262035
ISSN
1053-0770
DOI
10.1053/j.jvca.2020.11.004
language
English
LU publication?
yes
id
3900e139-5b18-4965-8a7c-2bf4efa2f4ed
date added to LUP
2021-01-11 16:10:07
date last changed
2024-06-13 04:16:04
@article{3900e139-5b18-4965-8a7c-2bf4efa2f4ed,
  abstract     = {{<p>Objective: To investigate the frequency, predictors, and outcomes of neurologic injury in adults treated with postcardiotomy extracorporeal membrane oxygenation (PC-ECMO). Design: A retrospective multicenter registry study. Setting: Twenty-one European institutions where cardiac surgery is performed. Participants: A total of 781 adult patients who required PC-ECMO during 2010 to 2018 were divided into patients with neurologic injury (NI) and patients without neurologic injury (NNI). Measurements and Main Results: Baseline and operative data, in-hospital outcomes, and long-term survival were compared between the NI and the NNI groups. Predictors of neurologic injury were identified. A subgroup analysis according to the type of neurologic injury was performed. Overall, NI occurred in 19% of patients in the overall series, but the proportion of patients with NI ranged from 0% to 65% among the centers. Ischemic stroke occurred in 84 patients and hemorrhagic stroke in 47 patients. Emergency procedure was the sole independent predictor of NI. In-hospital mortality was higher in the NI group than in the NNI group (79% v 61%, p &lt; 0.001). The one-year survival was lower in the NI group (17%) compared with the NNI group (37%). Long-term survival did not differ between patients with ischemic stroke and those with hemorrhagic stroke. Conclusion: Neurologic injury during PC-ECMO is common and associated with a dismal prognosis. There is considerable interinstitutional variation in the proportion of neurologic injury in PC-ECMO-treated adults. Well-known risk factors for stroke are not associated with neurologic injury in this setting.</p>}},
  author       = {{Toivonen, Fanni and Biancari, Fausto and Dalén, Magnus and Dell'Aquila, Angelo M. and Jónsson, Kristján and Fiore, Antonio and Mariscalco, Giovanni and El-Dean, Zein and Gatti, Giuseppe and Zipfel, Svante and Perrotti, Andrea and Bounader, Karl and Alkhamees, Khalid and Loforte, Antonio and Lechiancole, Andrea and Pol, Marek and Spadaccio, Cristiano and Pettinari, Matteo and De Keyzer, Dieter and Welp, Henryk and Lichtenberg, Artur and Saeed, Diyar and Ruggieri, Vito G. and Ragnarsson, Sigurdur}},
  issn         = {{1053-0770}},
  keywords     = {{extracorporeal membrane oxygenation; intracerebral hemorrhage; ischemic stroke; neurologic injury; outcome; postcardiotomy shock; stroke}},
  language     = {{eng}},
  month        = {{09}},
  number       = {{9}},
  pages        = {{2669--2680}},
  publisher    = {{Elsevier}},
  series       = {{Journal of Cardiothoracic and Vascular Anesthesia}},
  title        = {{Neurologic Injury in Patients Treated With Extracorporeal Membrane Oxygenation for Postcardiotomy Cardiogenic Shock}},
  url          = {{http://dx.doi.org/10.1053/j.jvca.2020.11.004}},
  doi          = {{10.1053/j.jvca.2020.11.004}},
  volume       = {{35}},
  year         = {{2021}},
}