Giuseppe
Emeritus
[Source: Archives of Neurology, full text: (LINK). Abstract, edited.]
Online First: August 8, 2011
Neurological Injury in Adults Treated With Extracorporeal Membrane Oxygenation
Farrah J. Mateen, MD; Rajanandini Muralidharan, MD; Russell T. Shinohara, MSc; Joseph E. Parisi, MD; Gregory J. Schears, MD; Eelco F. M. Wijdicks, MD, PhD
Arch Neurol. Published online August 8, 2011. doi:10.1001/archneurol.2011.209
Background
Extracorporeal membrane oxygenation (ECMO)<SUP> </SUP>may be urgently used as a last resort form of life support when<SUP> </SUP>all other treatment options for potentially reversible cardiopulmonary<SUP> </SUP>injury have failed.
Objective
To examine the range and frequency of neurological<SUP> </SUP>injury in ECMO-treated adults.
Design
Retrospective clinicopathological cohort study.
Setting
Mayo Clinic, Rochester, Minnesota.
Patients
A prospectively collected registry of all patients<SUP> </SUP>15 years or older treated with ECMO for 12 or more hours from<SUP> </SUP>January 2002 to April 2010.
Intervention
Patients were analyzed for potential risk<SUP> </SUP>factors for neurological events and death using logistic regression<SUP> </SUP>and Cox proportional hazards models.
Main Outcome Measures
Neurological diagnosis and/or death.
Results
A total of 87 adults were treated (35 female [40%];<SUP> </SUP>median age, 54 years [interquartile range, 31]; mean duration<SUP> </SUP>of ECMO, 91 hours [interquartile range, 100]; overall survival<SUP> </SUP>>7 days after ECMO, 52%). Neurological events occurred in 42<SUP> </SUP>patients who received ECMO (50%; 95% confidence interval [CI],<SUP> </SUP>39%-61%). Diagnoses included subarachnoid hemorrhage, ischemic<SUP> </SUP>watershed infarctions, hypoxic-ischemic encephalopathy, unexplained<SUP> </SUP>coma, and brain death. Death in patients who received ECMO who<SUP> </SUP>did not require antecedent cardiopulmonary resuscitation was<SUP> </SUP>associated with increased age (odds ratio, 1.24 per decade;<SUP> </SUP>95% CI, 1.03-1.50; P = .02) and lower minimum arterial<SUP> </SUP>oxygen pressure (odds ratio, 0.79; 95% CI, 0.68-0.92; P = .03).<SUP> </SUP>Although stroke was rarely diagnosed clinically, 9 of 10 brains<SUP> </SUP>studied at autopsy demonstrated hypoxic-ischemic and hemorrhagic<SUP> </SUP>lesions of vascular origin.
Conclusion
Severe neurological sequelae occur frequently<SUP> </SUP>in adult ECMO-treated patients with otherwise reversible cardiopulmonary<SUP> </SUP>injury (conservative estimate, 50%) and include a range of potentially<SUP> </SUP>fatal neurological diagnoses that may be due to the precipitating<SUP> </SUP>event and/or ECMO treatment.
Author Affiliations:
Departments of Neurology, School of Medicine (Dr Mateen), and Biostatistics, Bloomberg School of Public Health (Mr Shinohara), Johns Hopkins University, Baltimore, Maryland; and Departments of Neurology (Drs Mateen, Muralidharan, and Wijdicks), Pathology and Laboratory Medicine (Dr Parisi), and Anesthesiology (Dr Schears), Mayo Clinic, Rochester, Minnesota.
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Online First: August 8, 2011
Neurological Injury in Adults Treated With Extracorporeal Membrane Oxygenation
Farrah J. Mateen, MD; Rajanandini Muralidharan, MD; Russell T. Shinohara, MSc; Joseph E. Parisi, MD; Gregory J. Schears, MD; Eelco F. M. Wijdicks, MD, PhD
Arch Neurol. Published online August 8, 2011. doi:10.1001/archneurol.2011.209
Background
Extracorporeal membrane oxygenation (ECMO)<SUP> </SUP>may be urgently used as a last resort form of life support when<SUP> </SUP>all other treatment options for potentially reversible cardiopulmonary<SUP> </SUP>injury have failed.
Objective
To examine the range and frequency of neurological<SUP> </SUP>injury in ECMO-treated adults.
Design
Retrospective clinicopathological cohort study.
Setting
Mayo Clinic, Rochester, Minnesota.
Patients
A prospectively collected registry of all patients<SUP> </SUP>15 years or older treated with ECMO for 12 or more hours from<SUP> </SUP>January 2002 to April 2010.
Intervention
Patients were analyzed for potential risk<SUP> </SUP>factors for neurological events and death using logistic regression<SUP> </SUP>and Cox proportional hazards models.
Main Outcome Measures
Neurological diagnosis and/or death.
Results
A total of 87 adults were treated (35 female [40%];<SUP> </SUP>median age, 54 years [interquartile range, 31]; mean duration<SUP> </SUP>of ECMO, 91 hours [interquartile range, 100]; overall survival<SUP> </SUP>>7 days after ECMO, 52%). Neurological events occurred in 42<SUP> </SUP>patients who received ECMO (50%; 95% confidence interval [CI],<SUP> </SUP>39%-61%). Diagnoses included subarachnoid hemorrhage, ischemic<SUP> </SUP>watershed infarctions, hypoxic-ischemic encephalopathy, unexplained<SUP> </SUP>coma, and brain death. Death in patients who received ECMO who<SUP> </SUP>did not require antecedent cardiopulmonary resuscitation was<SUP> </SUP>associated with increased age (odds ratio, 1.24 per decade;<SUP> </SUP>95% CI, 1.03-1.50; P = .02) and lower minimum arterial<SUP> </SUP>oxygen pressure (odds ratio, 0.79; 95% CI, 0.68-0.92; P = .03).<SUP> </SUP>Although stroke was rarely diagnosed clinically, 9 of 10 brains<SUP> </SUP>studied at autopsy demonstrated hypoxic-ischemic and hemorrhagic<SUP> </SUP>lesions of vascular origin.
Conclusion
Severe neurological sequelae occur frequently<SUP> </SUP>in adult ECMO-treated patients with otherwise reversible cardiopulmonary<SUP> </SUP>injury (conservative estimate, 50%) and include a range of potentially<SUP> </SUP>fatal neurological diagnoses that may be due to the precipitating<SUP> </SUP>event and/or ECMO treatment.
Author Affiliations:
Departments of Neurology, School of Medicine (Dr Mateen), and Biostatistics, Bloomberg School of Public Health (Mr Shinohara), Johns Hopkins University, Baltimore, Maryland; and Departments of Neurology (Drs Mateen, Muralidharan, and Wijdicks), Pathology and Laboratory Medicine (Dr Parisi), and Anesthesiology (Dr Schears), Mayo Clinic, Rochester, Minnesota.