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Neurologic Injury in Patients Treated With Extracorporeal Membrane Oxygenation for Postcardiotomy Cardiogenic Shock
F. Toivonen, F. Biancari, M. Dalén, AM. Dell'Aquila, K. Jónsson, A. Fiore, G. Mariscalco, Z. El-Dean, G. Gatti, S. Zipfel, A. Perrotti, K. Bounader, K. Alkhamees, A. Loforte, A. Lechiancole, M. Pol, C. Spadaccio, M. Pettinari, D. De Keyzer, H....
Language English Country United States
Document type Journal Article, Multicenter Study
- MeSH
- Stroke MeSH
- Adult MeSH
- Cardiac Surgical Procedures * adverse effects MeSH
- Shock, Cardiogenic diagnosis epidemiology etiology MeSH
- Humans MeSH
- Extracorporeal Membrane Oxygenation * MeSH
- Hospital Mortality MeSH
- Retrospective Studies MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
OBJECTIVE: To investigate the frequency, predictors, and outcomes of neurologic injury in adults treated with postcardiotomy extracorporeal membrane oxygenation (PC-ECMO). DESIGN: A retrospective multicenter registry study. SETTING: Twenty-one European institutions where cardiac surgery is performed. PARTICIPANTS: A total of 781 adult patients who required PC-ECMO during 2010 to 2018 were divided into patients with neurologic injury (NI) and patients without neurologic injury (NNI). MEASUREMENTS AND MAIN RESULTS: Baseline and operative data, in-hospital outcomes, and long-term survival were compared between the NI and the NNI groups. Predictors of neurologic injury were identified. A subgroup analysis according to the type of neurologic injury was performed. Overall, NI occurred in 19% of patients in the overall series, but the proportion of patients with NI ranged from 0% to 65% among the centers. Ischemic stroke occurred in 84 patients and hemorrhagic stroke in 47 patients. Emergency procedure was the sole independent predictor of NI. In-hospital mortality was higher in the NI group than in the NNI group (79% v 61%, p < 0.001). The one-year survival was lower in the NI group (17%) compared with the NNI group (37%). Long-term survival did not differ between patients with ischemic stroke and those with hemorrhagic stroke. CONCLUSION: Neurologic injury during PC-ECMO is common and associated with a dismal prognosis. There is considerable interinstitutional variation in the proportion of neurologic injury in PC-ECMO-treated adults. Well-known risk factors for stroke are not associated with neurologic injury in this setting.
Cardiothoracic Department University Hospital of Udine Udine Italy
Department of Cardiac Surgery Sahlgrenska University Hospital Gothenburg Sweden
Department of Cardiothoracic Surgery Golden Jubilee National Hospital Glasgow United Kingdom
Department of Cardiothoracic Surgery Münster University Hospital Münster Germany
Department of Cardiothoracic Surgery Skane University Hospital and Lund University Lund Sweden
Department of Cardiovascular Surgery Universitätsklinikum Düsseldorf Düsseldorf Germany
Department of Cardiovascular Surgery Ziekenhuis Oost Limburg Genk Belgium
Department of Surgery University of Turku Turku Finland
Department of Thoracic and Cardio Vascular Surgery University Hospital Jean Minjoz Besançon France
Division of Cardiac Surgery Ospedali Riuniti Trieste Italy
Division of Cardiothoracic and Vascular Surgery Pontchaillou University Hospital Rennes France
Division of Cardiothoracic and Vascular Surgery Robert Debré University Hospital Reims France
Hamburg University Heart Center Hamburg Germany
Heart and Lung Center Helsinki University Hospital Helsinki Finland
Institute of Clinical and Experimental Medicine Prague Czech Republic
References provided by Crossref.org
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- $a OBJECTIVE: To investigate the frequency, predictors, and outcomes of neurologic injury in adults treated with postcardiotomy extracorporeal membrane oxygenation (PC-ECMO). DESIGN: A retrospective multicenter registry study. SETTING: Twenty-one European institutions where cardiac surgery is performed. PARTICIPANTS: A total of 781 adult patients who required PC-ECMO during 2010 to 2018 were divided into patients with neurologic injury (NI) and patients without neurologic injury (NNI). MEASUREMENTS AND MAIN RESULTS: Baseline and operative data, in-hospital outcomes, and long-term survival were compared between the NI and the NNI groups. Predictors of neurologic injury were identified. A subgroup analysis according to the type of neurologic injury was performed. Overall, NI occurred in 19% of patients in the overall series, but the proportion of patients with NI ranged from 0% to 65% among the centers. Ischemic stroke occurred in 84 patients and hemorrhagic stroke in 47 patients. Emergency procedure was the sole independent predictor of NI. In-hospital mortality was higher in the NI group than in the NNI group (79% v 61%, p < 0.001). The one-year survival was lower in the NI group (17%) compared with the NNI group (37%). Long-term survival did not differ between patients with ischemic stroke and those with hemorrhagic stroke. CONCLUSION: Neurologic injury during PC-ECMO is common and associated with a dismal prognosis. There is considerable interinstitutional variation in the proportion of neurologic injury in PC-ECMO-treated adults. Well-known risk factors for stroke are not associated with neurologic injury in this setting.
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