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

医学 体外膜肺氧合 冲程(发动机) 入射(几何) 心肺复苏术 单变量分析 体外心肺复苏 急诊医学 死亡率 回顾性队列研究 比例危险模型 危险系数 内科学 心脏病学 复苏 多元分析 置信区间 机械工程 物理 光学 工程类
作者
Jaeho Hwang,Andrew Kalra,Benjamin L. Shou,Glenn Whitman,Christopher S. Wilcox,Daniel Brodie,Akram Zaaqoq,Roberto Lorusso,Ken Uchino,Sung Min Cho
出处
期刊:Critical Care [BioMed Central]
卷期号:27 (1)
标识
DOI:10.1186/s13054-023-04707-z
摘要

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 2 and greater decrease between pre-ECMO PaCO 2 and post-cannulation 24-h PaCO 2 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.
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