Cerebrovascular Complications of COVID-19 on Venovenous Extracorporeal Membrane Oxygenation*

医学 体外膜肺氧合 四分位间距 冲程(发动机) 危险系数 2019年冠状病毒病(COVID-19) 相对风险 比例危险模型 内科学 麻醉 急诊医学 置信区间 疾病 传染病(医学专业) 机械工程 工程类
作者
Akram M. Zaaqoq,Matthew Griffee,Thu‐Lan Kelly,Jonathon P. Fanning,Silver Heinsar,Jacky Y. Suen,Sebastiano Maria Colombo,Gianluigi Li Bassi,Jeffrey Javidfar,Nicole White,John F. Fraser,Roberto Lorusso,Giles J. Peek,Sung‐Min Cho
出处
期刊:Critical Care Medicine [Lippincott Williams & Wilkins]
卷期号:51 (8): 1043-1053 被引量:5
标识
DOI:10.1097/ccm.0000000000005861
摘要

OBJECTIVES: Evidence of cerebrovascular complications in COVID-19 requiring venovenous extracorporeal membrane oxygenation (ECMO) is limited. Our study aims to characterize the prevalence and risk factors of stroke secondary to COVID-19 in patients on venovenous ECMO. DESIGN: We analyzed prospectively collected observational data, using univariable and multivariable survival modeling to identify risk factors for stroke. Cox proportional hazards and Fine-Gray models were used, with death and discharge treated as competing risks. SETTING: Three hundred eighty institutions in 53 countries in the COVID-19 Critical Care Consortium (COVID Critical) registry. PATIENTS: Adult COVID-19 patients who were supported by venovenous ECMO. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Five hundred ninety-five patients (median age [interquartile range], 51 yr [42–59 yr]; male: 70.8%) had venovenous ECMO support. Forty-three patients (7.2%) suffered strokes, 83.7% of which were hemorrhagic. In multivariable survival analysis, obesity (adjusted hazard ratio [aHR], 2.19; 95% CI, 1.05–4.59) and use of vasopressors before ECMO (aHR, 2.37; 95% CI, 1.08–5.22) were associated with an increased risk of stroke. Forty-eight-hour post-ECMO Pa co 2 –pre-ECMO Pa co 2 /pre-ECMO Pa co 2 (relative ΔPa co 2 ) of negative 26% and 48-hour post-ECMO Pa o 2 –pre-ECMO Pa o 2 /pre-ECMO Pa o 2 (relative ΔPa o 2 ) of positive 24% at 48 hours of ECMO initiation were observed in stroke patients in comparison to relative ΔPa co 2 of negative 17% and relative ΔPa o 2 of positive 7% in the nonstroke group. Patients with acute stroke had a 79% in-hospital mortality compared with 45% mortality for stroke-free patients. CONCLUSIONS: Our study highlights the association of obesity and pre-ECMO vasopressor use with the development of stroke in COVID-19 patients on venovenous ECMO. Also, the importance of relative decrease in Pa co 2 and moderate hyperoxia within 48 hours after ECMO initiation were additional risk factors.

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