Neurologic Injury in Adults Supported With Veno-Venous Extracorporeal Membrane Oxygenation for Respiratory Failure

Findings From the Extracorporeal Life Support Organization Database

Roberto Lorusso, Sandro Gelsomino, Orlando Parise, Michele Di Mauro, Fabio Barili, Gijs Geskes, Enrico Vizzardi, Peter T. Rycus, Raf Muellenbach, Thomas Mueller, Antonio Pesenti, Alain Combes, Giles J. Peek, Bjorn Frenckner, Matteo Di Nardo, Justyna Swol, Jos Maessen, Ravi R. Thiagarajan

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

OBJECTIVES:: To assess in-hospital neurologic (CNS) complications in adult patients undergoing veno-venous extracorporeal membrane oxygenation for respiratory failure. DESIGN:: Retrospective analysis of the Extracorporeal Life Support Organization’s data registry. SETTING:: Data reported to Extracorporeal Life Support Organization from 350 international extracorporeal membrane oxygenation centers during 1992–2015. PATIENTS:: Adults (≥ 18 yr old) supported with veno-venous extracorporeal membrane oxygenation for respiratory failure. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: We included 4,988 adults supported with veno-venous extracorporeal membrane oxygenation for respiratory failure. Neurologic injury was defined as brain death, seizures, stroke, and intracranial hemorrhage occurring during extracorporeal membrane oxygenation support. We used multivariable logistic regression to explore patient and extracorporeal membrane oxygenation factors associated with neurologic injury. Median age of the study cohort was 46 (interquartile range, 32–58). Four hundred twenty-six neurologic complications were reported in 356 patients (7.1%), and included 181 intracranial hemorrhage (42.5%), 100 brain deaths (23.5%), 85 stroke (19.9%), and 60 seizure events (14.1%). In-hospital mortality was significantly higher for those with CNS complications (75.8% vs 37.8%; p < 0.001) and varied by type of CNS injury; mortality was 79.6% in patients with intracranial hemorrhage, 68.2% in patients with stroke, and 50% in patients with seizures. Pre-extracorporeal membrane oxygenation cardiac arrest, continuous veno-venous hemofiltration, and hyperbilirubinemia during extracorporeal membrane oxygenation were associated with increased odds of neurologic injury. CONCLUSIONS:: Approximately 7% of adults supported with veno-venous extracorporeal membrane oxygenation for respiratory failure had neurologic injury. Intracranial hemorrhage was the most frequent type, and survival for patients with neurologic injury was poor. Future investigations should evaluate anticoagulation management as well as brain/extracorporeal membrane oxygenation interaction to reduce these life-threatening events.

Original languageEnglish (US)
JournalCritical Care Medicine
DOIs
StateAccepted/In press - May 22 2017

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Nervous System Trauma
Extracorporeal Membrane Oxygenation
Respiratory Insufficiency
Organizations
Databases
Intracranial Hemorrhages
Seizures
Brain Death
Stroke
Nervous System
Hemofiltration
Hyperbilirubinemia
Hospital Mortality
Heart Arrest
Registries

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Neurologic Injury in Adults Supported With Veno-Venous Extracorporeal Membrane Oxygenation for Respiratory Failure : Findings From the Extracorporeal Life Support Organization Database. / Lorusso, Roberto; Gelsomino, Sandro; Parise, Orlando; Di Mauro, Michele; Barili, Fabio; Geskes, Gijs; Vizzardi, Enrico; Rycus, Peter T.; Muellenbach, Raf; Mueller, Thomas; Pesenti, Antonio; Combes, Alain; Peek, Giles J.; Frenckner, Bjorn; Di Nardo, Matteo; Swol, Justyna; Maessen, Jos; Thiagarajan, Ravi R.

In: Critical Care Medicine, 22.05.2017.

Research output: Contribution to journalArticle

Lorusso, R, Gelsomino, S, Parise, O, Di Mauro, M, Barili, F, Geskes, G, Vizzardi, E, Rycus, PT, Muellenbach, R, Mueller, T, Pesenti, A, Combes, A, Peek, GJ, Frenckner, B, Di Nardo, M, Swol, J, Maessen, J & Thiagarajan, RR 2017, 'Neurologic Injury in Adults Supported With Veno-Venous Extracorporeal Membrane Oxygenation for Respiratory Failure: Findings From the Extracorporeal Life Support Organization Database', Critical Care Medicine. https://doi.org/10.1097/CCM.0000000000002502
Lorusso, Roberto ; Gelsomino, Sandro ; Parise, Orlando ; Di Mauro, Michele ; Barili, Fabio ; Geskes, Gijs ; Vizzardi, Enrico ; Rycus, Peter T. ; Muellenbach, Raf ; Mueller, Thomas ; Pesenti, Antonio ; Combes, Alain ; Peek, Giles J. ; Frenckner, Bjorn ; Di Nardo, Matteo ; Swol, Justyna ; Maessen, Jos ; Thiagarajan, Ravi R. / Neurologic Injury in Adults Supported With Veno-Venous Extracorporeal Membrane Oxygenation for Respiratory Failure : Findings From the Extracorporeal Life Support Organization Database. In: Critical Care Medicine. 2017.
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abstract = "OBJECTIVES:: To assess in-hospital neurologic (CNS) complications in adult patients undergoing veno-venous extracorporeal membrane oxygenation for respiratory failure. DESIGN:: Retrospective analysis of the Extracorporeal Life Support Organization’s data registry. SETTING:: Data reported to Extracorporeal Life Support Organization from 350 international extracorporeal membrane oxygenation centers during 1992–2015. PATIENTS:: Adults (≥ 18 yr old) supported with veno-venous extracorporeal membrane oxygenation for respiratory failure. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: We included 4,988 adults supported with veno-venous extracorporeal membrane oxygenation for respiratory failure. Neurologic injury was defined as brain death, seizures, stroke, and intracranial hemorrhage occurring during extracorporeal membrane oxygenation support. We used multivariable logistic regression to explore patient and extracorporeal membrane oxygenation factors associated with neurologic injury. Median age of the study cohort was 46 (interquartile range, 32–58). Four hundred twenty-six neurologic complications were reported in 356 patients (7.1{\%}), and included 181 intracranial hemorrhage (42.5{\%}), 100 brain deaths (23.5{\%}), 85 stroke (19.9{\%}), and 60 seizure events (14.1{\%}). In-hospital mortality was significantly higher for those with CNS complications (75.8{\%} vs 37.8{\%}; p < 0.001) and varied by type of CNS injury; mortality was 79.6{\%} in patients with intracranial hemorrhage, 68.2{\%} in patients with stroke, and 50{\%} in patients with seizures. Pre-extracorporeal membrane oxygenation cardiac arrest, continuous veno-venous hemofiltration, and hyperbilirubinemia during extracorporeal membrane oxygenation were associated with increased odds of neurologic injury. CONCLUSIONS:: Approximately 7{\%} of adults supported with veno-venous extracorporeal membrane oxygenation for respiratory failure had neurologic injury. Intracranial hemorrhage was the most frequent type, and survival for patients with neurologic injury was poor. Future investigations should evaluate anticoagulation management as well as brain/extracorporeal membrane oxygenation interaction to reduce these life-threatening events.",
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T1 - Neurologic Injury in Adults Supported With Veno-Venous Extracorporeal Membrane Oxygenation for Respiratory Failure

T2 - Findings From the Extracorporeal Life Support Organization Database

AU - Lorusso, Roberto

AU - Gelsomino, Sandro

AU - Parise, Orlando

AU - Di Mauro, Michele

AU - Barili, Fabio

AU - Geskes, Gijs

AU - Vizzardi, Enrico

AU - Rycus, Peter T.

AU - Muellenbach, Raf

AU - Mueller, Thomas

AU - Pesenti, Antonio

AU - Combes, Alain

AU - Peek, Giles J.

AU - Frenckner, Bjorn

AU - Di Nardo, Matteo

AU - Swol, Justyna

AU - Maessen, Jos

AU - Thiagarajan, Ravi R.

PY - 2017/5/22

Y1 - 2017/5/22

N2 - OBJECTIVES:: To assess in-hospital neurologic (CNS) complications in adult patients undergoing veno-venous extracorporeal membrane oxygenation for respiratory failure. DESIGN:: Retrospective analysis of the Extracorporeal Life Support Organization’s data registry. SETTING:: Data reported to Extracorporeal Life Support Organization from 350 international extracorporeal membrane oxygenation centers during 1992–2015. PATIENTS:: Adults (≥ 18 yr old) supported with veno-venous extracorporeal membrane oxygenation for respiratory failure. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: We included 4,988 adults supported with veno-venous extracorporeal membrane oxygenation for respiratory failure. Neurologic injury was defined as brain death, seizures, stroke, and intracranial hemorrhage occurring during extracorporeal membrane oxygenation support. We used multivariable logistic regression to explore patient and extracorporeal membrane oxygenation factors associated with neurologic injury. Median age of the study cohort was 46 (interquartile range, 32–58). Four hundred twenty-six neurologic complications were reported in 356 patients (7.1%), and included 181 intracranial hemorrhage (42.5%), 100 brain deaths (23.5%), 85 stroke (19.9%), and 60 seizure events (14.1%). In-hospital mortality was significantly higher for those with CNS complications (75.8% vs 37.8%; p < 0.001) and varied by type of CNS injury; mortality was 79.6% in patients with intracranial hemorrhage, 68.2% in patients with stroke, and 50% in patients with seizures. Pre-extracorporeal membrane oxygenation cardiac arrest, continuous veno-venous hemofiltration, and hyperbilirubinemia during extracorporeal membrane oxygenation were associated with increased odds of neurologic injury. CONCLUSIONS:: Approximately 7% of adults supported with veno-venous extracorporeal membrane oxygenation for respiratory failure had neurologic injury. Intracranial hemorrhage was the most frequent type, and survival for patients with neurologic injury was poor. Future investigations should evaluate anticoagulation management as well as brain/extracorporeal membrane oxygenation interaction to reduce these life-threatening events.

AB - OBJECTIVES:: To assess in-hospital neurologic (CNS) complications in adult patients undergoing veno-venous extracorporeal membrane oxygenation for respiratory failure. DESIGN:: Retrospective analysis of the Extracorporeal Life Support Organization’s data registry. SETTING:: Data reported to Extracorporeal Life Support Organization from 350 international extracorporeal membrane oxygenation centers during 1992–2015. PATIENTS:: Adults (≥ 18 yr old) supported with veno-venous extracorporeal membrane oxygenation for respiratory failure. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: We included 4,988 adults supported with veno-venous extracorporeal membrane oxygenation for respiratory failure. Neurologic injury was defined as brain death, seizures, stroke, and intracranial hemorrhage occurring during extracorporeal membrane oxygenation support. We used multivariable logistic regression to explore patient and extracorporeal membrane oxygenation factors associated with neurologic injury. Median age of the study cohort was 46 (interquartile range, 32–58). Four hundred twenty-six neurologic complications were reported in 356 patients (7.1%), and included 181 intracranial hemorrhage (42.5%), 100 brain deaths (23.5%), 85 stroke (19.9%), and 60 seizure events (14.1%). In-hospital mortality was significantly higher for those with CNS complications (75.8% vs 37.8%; p < 0.001) and varied by type of CNS injury; mortality was 79.6% in patients with intracranial hemorrhage, 68.2% in patients with stroke, and 50% in patients with seizures. Pre-extracorporeal membrane oxygenation cardiac arrest, continuous veno-venous hemofiltration, and hyperbilirubinemia during extracorporeal membrane oxygenation were associated with increased odds of neurologic injury. CONCLUSIONS:: Approximately 7% of adults supported with veno-venous extracorporeal membrane oxygenation for respiratory failure had neurologic injury. Intracranial hemorrhage was the most frequent type, and survival for patients with neurologic injury was poor. Future investigations should evaluate anticoagulation management as well as brain/extracorporeal membrane oxygenation interaction to reduce these life-threatening events.

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