Christopher Wilcox1, Eric Etchill2, Katherine Giuliano2, Yunis Mayasi3, Aaron M Gusdon4, Chun Woo Cho I2, Bo Soo Kim2, Errol L Bush5, Romergryko G Geocadin6, Glenn J Whitman2, Sung-Min Cho7. 1. Department of Neurosciences, Mercy Hospital of Buffalo, Buffalo, NY. 2. Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. 3. Neuroscience Critical Care, Departments of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurocritical Care, Avera Health, Sioux Falls, SD. 4. Neuroscience Critical Care, Departments of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosurgery, University of Texas Health Science Center, Houston, TX. 5. Division of Thoracic Surgery, D epartment of Surgery, Heart, and Vascular Institute, Johns Hopkins University School of Medicine, Baltimore, MD. 6. Neuroscience Critical Care, Departments of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. 7. Neuroscience Critical Care, Departments of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: csungmi1@jhmi.ed.
Abstract
OBJECTIVE: Acute brain injury (ABI) is common in venoarterial extracorporeal membrane oxygenation (VA-ECMO). One of the most common indications for use of VA-ECMO is postcardiotomy shock (PCS). The authors aimed to characterize the prevalence of ABI and its association with outcomes in this population. DESIGN: prospective observational. SETTING: Single-center tertiary care university hospital. PARTICIPANTS: Fifty-two consecutive patients treated for PCS with VA-ECMO from November 2017 to March 2020. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The median age of patients was 64 (interquartile range 44-84), 62% were male. Of 52 PCS patients treated with extracorporeal membrane oxygenation, 38% (n = 20) experienced acute brain injury. Ischemic stroke was the most common (n = 13, 25%). Patients with central versus peripheral cannulation experienced more ischemic and hemorrhagic strokes (8% v 38%, p = 0.04). Patients with intracardiac thrombus experienced more brain injury (n = 4, 8% p = 0.02). The in-hospital mortality in patients with brain injury was 90% (n = 18/20) compared to 78% (n = 25/32) in patients without brain injury. CONCLUSIONS: ABI is common in postcardiotomy VA-ECMO and associated with worse outcome. Patients with central recanalization experienced the majority of acute strokes. Intracardiac thrombus was significantly associated with acute brain injury.
OBJECTIVE: Acute brain injury (ABI) is common in venoarterial extracorporeal membrane oxygenation (VA-ECMO). One of the most common indications for use of VA-ECMO is postcardiotomy shock (PCS). The authors aimed to characterize the prevalence of ABI and its association with outcomes in this population. DESIGN: prospective observational. SETTING: Single-center tertiary care university hospital. PARTICIPANTS: Fifty-two consecutive patients treated for PCS with VA-ECMO from November 2017 to March 2020. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The median age of patients was 64 (interquartile range 44-84), 62% were male. Of 52 PCS patients treated with extracorporeal membrane oxygenation, 38% (n = 20) experienced acute brain injury. Ischemic stroke was the most common (n = 13, 25%). Patients with central versus peripheral cannulation experienced more ischemic and hemorrhagic strokes (8% v 38%, p = 0.04). Patients with intracardiac thrombus experienced more brain injury (n = 4, 8% p = 0.02). The in-hospital mortality in patients with brain injury was 90% (n = 18/20) compared to 78% (n = 25/32) in patients without brain injury. CONCLUSIONS: ABI is common in postcardiotomy VA-ECMO and associated with worse outcome. Patients with central recanalization experienced the majority of acute strokes. Intracardiac thrombus was significantly associated with acute brain injury.
Authors: Benjamin L Shou; Christopher Wilcox; Isabella Florissi; Andrew Kalra; Giorgio Caturegli; Lucy Q Zhang; Errol Bush; Bo Kim; Steven P Keller; Glenn J R Whitman; Sung-Min Cho Journal: Neurocrit Care Date: 2022-09-27 Impact factor: 3.532