![thebrain 9 db file location thebrain 9 db file location](https://usermanual.wiki/Document/SQLWorkbenchManual.1388874451-User-Guide-Page-1.png)
The charts of all VA-ECMO-treated patients were retrospectively reviewed and analyzed to identify those with neurological complications. In particular, any events occurring on ECMO were prospectively recorded in the ICU’s database. Information on medical history, clinical and biological parameters at ICU admission and during ICU stay was collected prospectively. Thus, we undertook this retrospective study to describe the frequencies, morbidities and mortalities of structural brain injuries (namely ischemic stroke and intracranial hemorrhage) occurring on VA-ECMO, and attempt to identify their associated risk factors.Īll patients admitted to our intensive care unit (ICU) over 8 years (2006–2014) who received VA-ECMO support were included. If such controllable brain-injury risk factors in VA-ECMO patients exist, they could impact patients’ outcomes. Pertinently, some risk factors may be controllable: a recent retrospective study on venovenous-(VV-)ECMO showed that rapid PaCO 2-level change at ECMO start was associated with intracranial bleeding. Moreover, risk factors for brain injury and specific lesions (i.e., intracranial bleeding and ischemic stroke) are poorly described. These differences across studies are mainly attributable to different brain-injury definitions, with some authors considering only intracranial bleeding, whiles others chose broader definitions. Among complications occurring in ECMO-treated patients, brain injury is among the most frequent, affecting 8–50%. Use of venoarterial-extracorporeal membrane oxygenation (VA-ECMO) to treat refractory cardiogenic shock has increased over the past decade.
![thebrain 9 db file location thebrain 9 db file location](https://media.springernature.com/m685/springer-static/image/art%3A10.1038%2Fs41467-021-24290-7/MediaObjects/41467_2021_24290_Fig1_HTML.png)
This study provides Class IV evidence that central VA-ECMO, low platelet count and rapid CO 2 change at ECMO start are associated with intracranial bleeding and high mortality. Intracranial bleeding occurs earlier and is associated with female sex, central VA-ECMO, low platelet count and rapid CO 2 change at ECMO start, and high mortality.
![thebrain 9 db file location thebrain 9 db file location](https://media.springernature.com/lw685/springer-static/image/art%3A10.1186%2Fs12987-018-0113-6/MediaObjects/12987_2018_113_Fig2_HTML.png)
Ischemic stroke is the most frequent, occurs after 1 week on ECMO support, has no specific risk factor and is not associated with higher mortality. Neurological events are frequent in VA-ECMO-treated patients. In a nested case–control study, rapid CO 2-level change from before-to-after ECMO start also seemed to be associated with intracranial bleeding. Female sex, central VA-ECMO and platelets < 100 giga/L at ECMO start were independently associated with intracranial bleeding with respective odds ratios of 2.9, 3.8 and 3.7. Multivariable analysis retained only platelet level > 350 giga/L as being associated with ischemic stroke. Intracranial bleeding but not ischemic stroke was associated with higher mortality. ResultsĪmong 878 VA-ECMO-treated patients, 65 (7.4%) developed an ECMO-related brain injury: 42 (5.3%) ischemic strokes and 20 (2.8%) intracranial bleeding, occurring after a median of 11 and 5 days of support, respectively. Retrospective observational study conducted, from 2006 to 2014, in a tertiary referral center on patients who developed a neurological complication(s) on VA-ECMO. Our objective was to describe frequencies, outcomes and risk factors for neurological complications (ischemic stroke and intracranial bleeding) in patients receiving VA-ECMO. Structural neurological complications (ischemic stroke and intracranial bleeding) and their risk factors in patients receiving venoarterial-extracorporeal membrane oxygenation (VA-ECMO) are poorly described.