Wiest, Clemens and Mueller, Thomas and Lubnow, Matthias and Fisser, Christoph and Philipp, Alois and Foltan, Maik and Schneckenpointner, Roland and Malfertheiner, Maximilian (2023) Intracranial hemorrhage in a large cohort of patients supported with veno-venous ECMO. A retrospective single-center analysis. PERFUSION-UK. ISSN 0267-6591, 1477-111X
Full text not available from this repository. (Request a copy)Abstract
Background: Intracranial bleeding (ICB) is a serious complication during veno-venous extracorporeal membrane oxygenation (V-V ECMO), with potentially fatal consequences.Purpose: This study aimed to evaluate the incidence, time of detection of ICB among patients treated with V-V ECMO and potential risk factors for developing ICB during V-V ECMO.Methods: Five hundred fifty six patients were included in this retrospective single center analysis.Results: Median time on V-V ECMO was 9 (IQR 6-15) days. Intracranial bleeding during V-V ECMO was detected in 10.9% of all patients (61 patients with ICB). Only 17 patients with ICB presented obvious clinical symptoms. Intracranial bleeding was detected on cerebral imaging in median after 5 days (IQR 1-14) after starting V-V ECMO. Overall survival to hospital discharge was 63.7% (ICB: 29.5%). Risk factors of ICB before starting V-V ECMO in univariable analysis were platelets <100/nl (OR: 3.82), creatinine >1.5mg/dl (OR: 1.98), norepinephrine >2.5mg/h (OR: 2.5), ASAT >80U/L (OR: 1.86), blood-urea >100mg/dl (OR: 1.81) and LDH >550u/L (OR: 2.07). Factors associated with cannulation were rapid decrease in paCO(2) >35mmHg (OR: 2.56) and rapid decrease in norepinephrine >1mg/h (OR: 2.53). Multivariable analysis revealed low platelets, high paCO(2) before ECMO, and rapid drop in paCO(2) after V-V ECMO initiation as significant risk factors for ICB.Conclusion: The results emphasize that ICB is a frequent complication during V-V ECMO. Many bleedings were incidental findings, therefore screening for ICB is advisable. The univariate risk factors reflect the underlying disease severity, coagulation disorders and peri-cannulation factors, and may help to identify patients at risk.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | EXTRACORPOREAL MEMBRANE-OXYGENATION; RESPIRATORY-FAILURE; BRAIN-INJURY; LIFE; ADULTS; veno-venous extracorporeal membrane oxygenation; intracranial bleeding; intracranial hemorrhage; incidence; risk factors |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Herz-, Thorax- und herznahe Gefäßchirurgie Medicine > Lehrstuhl für Innere Medizin II |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 12 Mar 2024 10:41 |
| Last Modified: | 13 Mar 2024 07:08 |
| URI: | https://pred.uni-regensburg.de/id/eprint/59400 |
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