TY - UNPB
T1 - Epidemiology of Ischemic Stroke and Hemorrhagic Stroke in Venoarterial Extracorporeal Membrane Oxygenation
AU - Hwang, Jaeho
AU - Kalra, Andrew
AU - Shou, Benjamin L
AU - Whitman, Glenn
AU - Wilcox, Christopher
AU - Brodie, Daniel
AU - Zaaqoq, Akram M
AU - Lorusso, Roberto
AU - Uchino, Ken
AU - Cho, Sung-Min
PY - 2023/7/31
Y1 - 2023/7/31
N2 - BACKGROUND: While venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides lifesaving support for cardiopulmonary failure, complications may arise that increase mortality, with few studies focusing on ischemic/hemorrhagic stroke. We aimed to determine the trends of stroke incidence and mortality, associations with each other, and associations with total case volume at each Extracorporeal Life Support Organization (ELSO) center. METHODS: Retrospective analysis of ELSO registry, including adult VA-ECMO patients from 534 international centers between 2012-2021, excluding extracorporeal cardiopulmonary resuscitation. Cochran-Armitage test and Poisson regression were used for trend analysis of stroke incidence and mortality. Kaplan-Meier curves, hazard functions, and multivariable logistic regression were used to study the impact of stroke on 90-day mortality. RESULTS: Of 33,041 patients (median age = 58 years, female = 32%), 4% developed ischemic stroke, and 2% developed hemorrhagic stroke. Ischemic stroke incidence increased (×1.21/year, p < 0.0001), while hemorrhagic stroke incidence remained stable, and overall 90-day mortality declined (1.78%/year, p < 0.0001). Ischemic/hemorrhagic strokes were associated with increased overall 90-day mortality (OR = 3.29, 3.99 respectively, both p < 0.0001) after controlling for pre-selected covariates, including age, pre/post-cannulation lab values, ECMO duration, center volume, and on-ECMO complications. Total center volume was associated positively with ischemic/hemorrhagic stroke incidences (OR = 1.039, 1.053 per-additional-100-cases respectively, both p = 0.022), but inversely with 90-day mortality (OR = 0.909 per-additional-100-cases, p < 0.0001). Hazard of death was highest in the first several days of VA-ECMO. CONCLUSION: In VA-ECMO patients, while the reported ischemic stroke incidence steadily increased over time, 90-day mortality decreased. ELSO centers with higher case volumes reported greater stroke incidence, but lower mortality. Both ischemic/hemorrhagic strokes were associated with increased mortality.
AB - BACKGROUND: While venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides lifesaving support for cardiopulmonary failure, complications may arise that increase mortality, with few studies focusing on ischemic/hemorrhagic stroke. We aimed to determine the trends of stroke incidence and mortality, associations with each other, and associations with total case volume at each Extracorporeal Life Support Organization (ELSO) center. METHODS: Retrospective analysis of ELSO registry, including adult VA-ECMO patients from 534 international centers between 2012-2021, excluding extracorporeal cardiopulmonary resuscitation. Cochran-Armitage test and Poisson regression were used for trend analysis of stroke incidence and mortality. Kaplan-Meier curves, hazard functions, and multivariable logistic regression were used to study the impact of stroke on 90-day mortality. RESULTS: Of 33,041 patients (median age = 58 years, female = 32%), 4% developed ischemic stroke, and 2% developed hemorrhagic stroke. Ischemic stroke incidence increased (×1.21/year, p < 0.0001), while hemorrhagic stroke incidence remained stable, and overall 90-day mortality declined (1.78%/year, p < 0.0001). Ischemic/hemorrhagic strokes were associated with increased overall 90-day mortality (OR = 3.29, 3.99 respectively, both p < 0.0001) after controlling for pre-selected covariates, including age, pre/post-cannulation lab values, ECMO duration, center volume, and on-ECMO complications. Total center volume was associated positively with ischemic/hemorrhagic stroke incidences (OR = 1.039, 1.053 per-additional-100-cases respectively, both p = 0.022), but inversely with 90-day mortality (OR = 0.909 per-additional-100-cases, p < 0.0001). Hazard of death was highest in the first several days of VA-ECMO. CONCLUSION: In VA-ECMO patients, while the reported ischemic stroke incidence steadily increased over time, 90-day mortality decreased. ELSO centers with higher case volumes reported greater stroke incidence, but lower mortality. Both ischemic/hemorrhagic strokes were associated with increased mortality.
KW - Mortality
KW - Stroke
KW - Trend
KW - Venoarterial ECMO
U2 - 10.21203/rs.3.rs-3200908/v1
DO - 10.21203/rs.3.rs-3200908/v1
M3 - Preprint
T3 - Research Square
BT - Epidemiology of Ischemic Stroke and Hemorrhagic Stroke in Venoarterial Extracorporeal Membrane Oxygenation
ER -