In-Hospital Neurologic Complications in Adult Patients Undergoing Venoarterial Extracorporeal Membrane Oxygenation: Results from the Extracorporeal Life Support Organization Registry

Roberto Lorusso, Fabio Barili, Michele Di Mauro, Sandro Gelsomino, Orlando Parise, Peter T. Rycus, Jos Maessen, Thomas Mueller, Raf Muellenbach, Jan Belohlavek, Giles J. Peek, Alain Combes, Bjorn Frenckner, Antonio Pesenti, Ravi R. Thiagarajan

Research output: Contribution to journalArticle

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Abstract

Objectives: To elucidate the epidemiology, complication profiles, hospital outcome, and predisposing factors of CNS complications occurring during venoarterial extracorporeal membrane oxygenation in adults. Design: Retrospective analysis of the Extracorporeal Life Support Organization registry. Setting: Data reported to Extracorporeal Life Support Organization by 230 extracorporeal membrane oxygenation centers from 1992 to 2013. Patients: Patients more than 16 years old supported with a single-run of venoarterial extracorporeal membrane oxygenation. Interventions: None. Measurements and Main Results: We examined 4,522 adult patients supported with venoarterial extracorporeal membrane oxygenation and included in the Extracorporeal Life Support Organization registry. Venoarterial extracorporeal membrane oxygenation was used for cardiac dysfunction in 3,005 patients (66.5%), cardiopulmonary resuscitation in 877 patients (19.4%), and respiratory failure in 640 patients (14.1%), respectively. Multivariate logistic regression was performed to identify factors independently associated with CNS injury. Neurologic complications occurred in 682 patients (15.1%), and included brain death in 358 patients (7.9%), cerebral infarction in 161 patients (3.6%), seizures in 83 patients (1.8%), and cerebral hemorrhage in 80 patients (1.8%). Multiple CNS complications in the same patient occurred in 70 cases. Hospital mortality in patients with CNS complications was 89%, compared with 57% in patients without (p < 0.001). In a multivariable model, age, pre-extracorporeal membrane oxygenation cardiac arrest, the use of inotropes on extracorporeal membrane oxygenation, and post-extracorporeal membrane oxygenation hypoglycemia were shown to be associated with CNS complications. Conclusions: Neurologic complications in adult patients on venoarterial extracorporeal membrane oxygenation support are common and associated with poor survival. Further research should focus on better understanding and management of brain/extracorporeal membrane oxygenation interaction to avoid such catastrophic complications.

Original languageEnglish (US)
Pages (from-to)e964-e972
JournalCritical Care Medicine
Volume44
Issue number10
DOIs
StatePublished - Oct 1 2016
Externally publishedYes

Fingerprint

Extracorporeal Membrane Oxygenation
Nervous System
Registries
Organizations
Brain Death
Cerebral Infarction
Cardiopulmonary Resuscitation
Cerebral Hemorrhage
Hospital Mortality
Heart Arrest
Hypoglycemia
Respiratory Insufficiency
Causality

Keywords

  • cardiac-assist device
  • cardiopulmonary resuscitation
  • cerebrovascular disorders
  • extracorporeal circulation

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

In-Hospital Neurologic Complications in Adult Patients Undergoing Venoarterial Extracorporeal Membrane Oxygenation : Results from the Extracorporeal Life Support Organization Registry. / Lorusso, Roberto; Barili, Fabio; Mauro, Michele Di; Gelsomino, Sandro; Parise, Orlando; Rycus, Peter T.; Maessen, Jos; Mueller, Thomas; Muellenbach, Raf; Belohlavek, Jan; Peek, Giles J.; Combes, Alain; Frenckner, Bjorn; Pesenti, Antonio; Thiagarajan, Ravi R.

In: Critical Care Medicine, Vol. 44, No. 10, 01.10.2016, p. e964-e972.

Research output: Contribution to journalArticle

Lorusso, R, Barili, F, Mauro, MD, Gelsomino, S, Parise, O, Rycus, PT, Maessen, J, Mueller, T, Muellenbach, R, Belohlavek, J, Peek, GJ, Combes, A, Frenckner, B, Pesenti, A & Thiagarajan, RR 2016, 'In-Hospital Neurologic Complications in Adult Patients Undergoing Venoarterial Extracorporeal Membrane Oxygenation: Results from the Extracorporeal Life Support Organization Registry', Critical Care Medicine, vol. 44, no. 10, pp. e964-e972. https://doi.org/10.1097/CCM.0000000000001865
Lorusso, Roberto ; Barili, Fabio ; Mauro, Michele Di ; Gelsomino, Sandro ; Parise, Orlando ; Rycus, Peter T. ; Maessen, Jos ; Mueller, Thomas ; Muellenbach, Raf ; Belohlavek, Jan ; Peek, Giles J. ; Combes, Alain ; Frenckner, Bjorn ; Pesenti, Antonio ; Thiagarajan, Ravi R. / In-Hospital Neurologic Complications in Adult Patients Undergoing Venoarterial Extracorporeal Membrane Oxygenation : Results from the Extracorporeal Life Support Organization Registry. In: Critical Care Medicine. 2016 ; Vol. 44, No. 10. pp. e964-e972.
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abstract = "Objectives: To elucidate the epidemiology, complication profiles, hospital outcome, and predisposing factors of CNS complications occurring during venoarterial extracorporeal membrane oxygenation in adults. Design: Retrospective analysis of the Extracorporeal Life Support Organization registry. Setting: Data reported to Extracorporeal Life Support Organization by 230 extracorporeal membrane oxygenation centers from 1992 to 2013. Patients: Patients more than 16 years old supported with a single-run of venoarterial extracorporeal membrane oxygenation. Interventions: None. Measurements and Main Results: We examined 4,522 adult patients supported with venoarterial extracorporeal membrane oxygenation and included in the Extracorporeal Life Support Organization registry. Venoarterial extracorporeal membrane oxygenation was used for cardiac dysfunction in 3,005 patients (66.5{\%}), cardiopulmonary resuscitation in 877 patients (19.4{\%}), and respiratory failure in 640 patients (14.1{\%}), respectively. Multivariate logistic regression was performed to identify factors independently associated with CNS injury. Neurologic complications occurred in 682 patients (15.1{\%}), and included brain death in 358 patients (7.9{\%}), cerebral infarction in 161 patients (3.6{\%}), seizures in 83 patients (1.8{\%}), and cerebral hemorrhage in 80 patients (1.8{\%}). Multiple CNS complications in the same patient occurred in 70 cases. Hospital mortality in patients with CNS complications was 89{\%}, compared with 57{\%} in patients without (p < 0.001). In a multivariable model, age, pre-extracorporeal membrane oxygenation cardiac arrest, the use of inotropes on extracorporeal membrane oxygenation, and post-extracorporeal membrane oxygenation hypoglycemia were shown to be associated with CNS complications. Conclusions: Neurologic complications in adult patients on venoarterial extracorporeal membrane oxygenation support are common and associated with poor survival. Further research should focus on better understanding and management of brain/extracorporeal membrane oxygenation interaction to avoid such catastrophic complications.",
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T2 - Results from the Extracorporeal Life Support Organization Registry

AU - Lorusso, Roberto

AU - Barili, Fabio

AU - Mauro, Michele Di

AU - Gelsomino, Sandro

AU - Parise, Orlando

AU - Rycus, Peter T.

AU - Maessen, Jos

AU - Mueller, Thomas

AU - Muellenbach, Raf

AU - Belohlavek, Jan

AU - Peek, Giles J.

AU - Combes, Alain

AU - Frenckner, Bjorn

AU - Pesenti, Antonio

AU - Thiagarajan, Ravi R.

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N2 - Objectives: To elucidate the epidemiology, complication profiles, hospital outcome, and predisposing factors of CNS complications occurring during venoarterial extracorporeal membrane oxygenation in adults. Design: Retrospective analysis of the Extracorporeal Life Support Organization registry. Setting: Data reported to Extracorporeal Life Support Organization by 230 extracorporeal membrane oxygenation centers from 1992 to 2013. Patients: Patients more than 16 years old supported with a single-run of venoarterial extracorporeal membrane oxygenation. Interventions: None. Measurements and Main Results: We examined 4,522 adult patients supported with venoarterial extracorporeal membrane oxygenation and included in the Extracorporeal Life Support Organization registry. Venoarterial extracorporeal membrane oxygenation was used for cardiac dysfunction in 3,005 patients (66.5%), cardiopulmonary resuscitation in 877 patients (19.4%), and respiratory failure in 640 patients (14.1%), respectively. Multivariate logistic regression was performed to identify factors independently associated with CNS injury. Neurologic complications occurred in 682 patients (15.1%), and included brain death in 358 patients (7.9%), cerebral infarction in 161 patients (3.6%), seizures in 83 patients (1.8%), and cerebral hemorrhage in 80 patients (1.8%). Multiple CNS complications in the same patient occurred in 70 cases. Hospital mortality in patients with CNS complications was 89%, compared with 57% in patients without (p < 0.001). In a multivariable model, age, pre-extracorporeal membrane oxygenation cardiac arrest, the use of inotropes on extracorporeal membrane oxygenation, and post-extracorporeal membrane oxygenation hypoglycemia were shown to be associated with CNS complications. Conclusions: Neurologic complications in adult patients on venoarterial extracorporeal membrane oxygenation support are common and associated with poor survival. Further research should focus on better understanding and management of brain/extracorporeal membrane oxygenation interaction to avoid such catastrophic complications.

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KW - cardiac-assist device

KW - cardiopulmonary resuscitation

KW - cerebrovascular disorders

KW - extracorporeal circulation

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