Epidemiology of ischemic stroke and hemorrhagic stroke in venoarterial extracorporeal membrane oxygenation

Jaeho Hwang, Andrew Kalra, Benjamin L Shou, Glenn Whitman, Christopher Wilcox, Daniel Brodie, Akram M Zaaqoq, Roberto Lorusso, Ken Uchino, Sung-Min Cho*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND: While venoarterial extracorporeal membrane oxygenation (V-A ECMO) provides lifesaving support for cardiopulmonary failure, complications may increase mortality, with few studies focusing on ischemic/hemorrhagic stroke. We aimed to determine the trends and associations of stroke incidence and mortality, and their risk factors, including the effects of annual case volumes of ECMO centers. METHODS: Retrospective analysis was performed on the Extracorporeal Life Support Organization (ELSO) registry, including adult V-A ECMO patients from 534 international centers between 2012 and 2021, excluding extracorporeal cardiopulmonary resuscitation. Temporal trend analyses were performed for stroke incidence and mortality. Univariate testing, multivariable regression, and survival analysis were used to evaluate the associations of stroke, 90-day mortality, and impact of annual center volume. RESULTS: Of 33,041 patients, 20,297 had mortality data, and 12,327 were included in the logistic regression. Between 2012 and 2021, ischemic stroke incidence increased (p?<?0.0001), hemorrhagic stroke incidence remained stable, and overall 90-day mortality declined (p?<?0.0001). Higher 24-h PaO and greater decrease between pre-ECMO PaCO and post-cannulation 24-h PaCO were associated with greater ischemic stroke incidence, while annual case volume was not. Ischemic/hemorrhagic strokes were associated with increased 90-day mortality (both p?<?0.0001), while higher annual case volume was associated with lower 90-day mortality (p?=?0.001). Hazard of death was highest in the first several days of V-A ECMO. CONCLUSION: In V-A ECMO patients between 2012 and 2021, 90-day mortality decreased, while ischemic stroke incidence increased. ELSO centers with higher annual case volumes had lower mortality, but were not associated with ischemic/hemorrhagic stroke incidence. Both ischemic/hemorrhagic strokes were associated with increased mortality.
Original languageEnglish
Article number433
Number of pages11
JournalCritical Care
Volume27
Issue number1
DOIs
Publication statusPublished - 9 Nov 2023

Keywords

  • Mortality
  • Stroke
  • Trend
  • Venoarterial ECMO
  • Adult
  • Humans
  • Extracorporeal Membrane Oxygenation/adverse effects
  • Hemorrhagic Stroke/etiology
  • Retrospective Studies
  • Ischemic Stroke/etiology
  • Stroke/epidemiology etiology
  • Ischemia/etiology
  • Registries

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