Fanni Toivonen1, Fausto Biancari2, Magnus Dalén3, Angelo M Dell'Aquila4, Kristján Jónsson5, Antonio Fiore6, Giovanni Mariscalco7, Zein El-Dean7, Giuseppe Gatti8, Svante Zipfel9, Andrea Perrotti10, Karl Bounader11, Khalid Alkhamees12, Antonio Loforte13, Andrea Lechiancole14, Marek Pol15, Cristiano Spadaccio16, Matteo Pettinari17, Dieter De Keyzer18, Henryk Welp18, Artur Lichtenberg18, Diyar Saeed18, Vito G Ruggieri19, Sigurdur Ragnarsson20. 1. Department of Cardiothoracic Surgery, Skane University Hospital and Lund University, Lund, Sweden. 2. Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland; Research Unit of Surgery, Anesthesiology and Critical Care, Faculty of Medicine, University of Oulu, Oulu, Finland; Department of Surgery, University of Turku, Turku, Finland. 3. Department of Molecular Medicine and Surgery, Department of Cardiac Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. 4. Department of Cardiothoracic Surgery, Münster University Hospital, Münster, Germany. 5. Department of Cardiac Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden. 6. Department of Cardiothoracic Surgery, Henri Mondor University Hospital, AP-HP, Paris-Est University, Créteil, France. 7. Department of Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom. 8. Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy. 9. Hamburg University Heart Center, Hamburg, Germany. 10. Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France. 11. Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France. 12. Prince Sultan Cardiac Center, Al Hassa, Saudi Arabia. 13. Department of Cardiothoracic, Transplantation and Vascular Surgery, S. Orsola Hospital, University of Bologna, Bologna, Italy. 14. Cardiothoracic Department, University Hospital of Udine, Udine, Italy. 15. Institute of Clinical and Experimental Medicine, Prague, Czech Republic. 16. Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, United Kingdom. 17. Department of Cardiovascular Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium. 18. Department of Cardiovascular Surgery, Universitätsklinikum Düsseldorf, Düsseldorf, Germany. 19. Division of Cardiothoracic and Vascular Surgery, Robert Debré University Hospital, Reims, France. 20. Department of Cardiothoracic Surgery, Skane University Hospital and Lund University, Lund, Sweden. Electronic address: sigurdur.ragnarsson@med.lu.se.
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 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.
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.
Authors: Sasa Rajsic; Benedikt Treml; Dragana Jadzic; Robert Breitkopf; Christoph Oberleitner; Marina Popovic Krneta; Zoran Bukumiric Journal: Ann Intensive Care Date: 2022-10-05 Impact factor: 10.318