Abstract:
OBJECTIVES:To assess in-hospital neurologic (CNS) complications in adult patients undergoing veno-venous extracorporeal membrane oxygenation for respiratory failure. DESIGN:Retrospective analysis of the Extracorporeal Life Support Organization's data registry. SETTING:Data reported to Extracorporeal Life Support Organization from 350 international extracorporeal membrane oxygenation centers during 1992-2015. PATIENTS:Adults (≥ 18 yr old) supported with veno-venous extracorporeal membrane oxygenation for respiratory failure. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:We included 4,988 adults supported with veno-venous extracorporeal membrane oxygenation for respiratory failure. Neurologic injury was defined as brain death, seizures, stroke, and intracranial hemorrhage occurring during extracorporeal membrane oxygenation support. We used multivariable logistic regression to explore patient and extracorporeal membrane oxygenation factors associated with neurologic injury. Median age of the study cohort was 46 (interquartile range, 32-58). Four hundred twenty-six neurologic complications were reported in 356 patients (7.1%), and included 181 intracranial hemorrhage (42.5%), 100 brain deaths (23.5%), 85 stroke (19.9%), and 60 seizure events (14.1%). In-hospital mortality was significantly higher for those with CNS complications (75.8% vs 37.8%; p < 0.001) and varied by type of CNS injury; mortality was 79.6% in patients with intracranial hemorrhage, 68.2% in patients with stroke, and 50% in patients with seizures. Pre-extracorporeal membrane oxygenation cardiac arrest, continuous veno-venous hemofiltration, and hyperbilirubinemia during extracorporeal membrane oxygenation were associated with increased odds of neurologic injury. CONCLUSIONS:Approximately 7% of adults supported with veno-venous extracorporeal membrane oxygenation for respiratory failure had neurologic injury. Intracranial hemorrhage was the most frequent type, and survival for patients with neurologic injury was poor. Future investigations should evaluate anticoagulation management as well as brain/extracorporeal membrane oxygenation interaction to reduce these life-threatening events.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Lorusso R,Gelsomino S,Parise O,Di Mauro M,Barili F,Geskes G,Vizzardi E,Rycus PT,Muellenbach R,Mueller T,Pesenti A,Combes A,Peek G,Frenckner B,Di Nardo M,Swol J,Maessen J,Thiagarajan RRdoi
10.1097/CCM.0000000000002502subject
Has Abstractpub_date
2017-08-01 00:00:00pages
1389-1397issue
8eissn
0090-3493issn
1530-0293journal_volume
45pub_type
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pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:2005-05-01 00:00:00
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更新日期:1993-05-01 00:00:00
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更新日期:2003-06-01 00:00:00
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更新日期:2014-02-01 00:00:00
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更新日期:2011-01-01 00:00:00
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更新日期:1993-02-01 00:00:00
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更新日期:1989-11-01 00:00:00
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更新日期:2012-07-01 00:00:00