Stroke patterns and cannulation strategy during veno-arterial extracorporeal membrane support.
Cerebrovascular accident
ECMO
Extracorporeal membrane support
Stroke
Journal
Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs
ISSN: 1619-0904
Titre abrégé: J Artif Organs
Pays: Japan
ID NLM: 9815648
Informations de publication
Date de publication:
Sep 2022
Sep 2022
Historique:
received:
08
04
2021
accepted:
22
10
2021
pubmed:
10
11
2021
medline:
31
8
2022
entrez:
9
11
2021
Statut:
ppublish
Résumé
Stroke has potentially devastating consequences for patients receiving veno-arterial extracorporeal membrane support (VA-ECMO). Arterial cannulation sites for VA-ECMO include the ascending aorta, axillary artery, and femoral artery. However, the influence of cannulation site on stroke risk has not been well described. The purpose of this study was to investigate the association between occurrence and patterns of stroke with ECMO arterial cannulation sites. We retrospectively reviewed 414 consecutive patients who received VA-ECMO support for cardiogenic shock between March 2007 and May 2018. Patients were categorized by cannulation strategy. The rates, subtype and location of strokes as assessed by neuroimaging during and after VA-ECMO support were analyzed. Median age was 61 years (IQR 50-69); 67% were men. 77 patients were cannulated via the ascending aorta (17%), 31 via the axillary artery (7%), and 306 (69%) via the femoral artery. In total, 26 patients (6.3%) developed 30 stroke lesions at a median of 6.0 (IQR 3.1-8.7) days after ECMO cannulation. Ischemic stroke was the most common subtype (64%), followed by hemorrhagic transformation (20%) and hemorrhagic stroke (16%). Location by CT was right hemispheric in 38%, left hemispheric in 24%, bilateral in 21%, and vertebrobasilar in 17%. The incidence of stroke was similar across cannulation strategies: aorta (n = 5, 6.5%), axillary artery (n = 2, 6.5%), and femoral artery (n = 19, 6.2%), (p = 0.99). Incidence of stroke does not appear to differ among patients cannulated via the ascending aorta, axillary artery, or femoral artery. Ischemic stroke was the most common subtype of stroke.
Identifiants
pubmed: 34751886
doi: 10.1007/s10047-021-01300-5
pii: 10.1007/s10047-021-01300-5
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
231-237Informations de copyright
© 2021. The Japanese Society for Artificial Organs.
Références
Gerke AK, Tang F, Cavanaugh JE, Doerschug KC, Polgreen PM. Increased trend in extracorporeal membrane oxygenation use by adults in the United States since 2007. BMC Res Notes. 2015;8:686.
doi: 10.1186/s13104-015-1678-7
Sauer CM, Yuh DD, Bonde P. Extracorporeal membrane oxygenation use has increased by 433% in adults in the United States from 2006 to 2011. Asaio j. 2015;61:31–6.
doi: 10.1097/MAT.0000000000000160
McCarthy FH, McDermott KM, Kini V, Gutsche JT, Wald JW, Xie D, et al. Trends in U.S. Extracorporeal Membrane Oxygenation Use and Outcomes: 2002–2012. Semin Thorac Cardiovasc Surg. 2015;27:81–88.
Shah M, Patnaik S, Patel B, Ram P, Garg L, Agarwal M, et al. Trends in mechanical circulatory support use and hospital mortality among patients with acute myocardial infarction and non-infarction related cardiogenic shock in the United States. Clin Res Cardiol. 2018;107:287–303.
doi: 10.1007/s00392-017-1182-2
El Sibai R, Bachir R, El Sayed M. ECMO use and mortality in adult patients with cardiogenic shock: a retrospective observational study in U.S. hospitals. BMC Emerg Med. 2018;18:20.
Keebler ME, Haddad EV, Choi CW, McGrane S, Zalawadiya S, Schlendorf KH, et al. Venoarterial Extracorporeal Membrane Oxygenation in Cardiogenic Shock. JACC: Heart Failure. 2018;6:503–516.
Le Guennec L, Cholet C, Huang F, Schmidt M, Brechot N, Hekimian G, et al. Ischemic and hemorrhagic brain injury during venoarterial-extracorporeal membrane oxygenation. Ann Intensive Care. 2018;8:129.
doi: 10.1186/s13613-018-0475-6
Cheng R, Hachamovitch R, Kittleson M, Patel J, Arabia F, Moriguchi J, et al. Complications of extracorporeal membrane oxygenation for treatment of cardiogenic shock and cardiac arrest: a meta-analysis of 1,866 adult patients. Ann Thorac Surg. 2014;97:610–6.
doi: 10.1016/j.athoracsur.2013.09.008
Omar HR, Mirsaeidi M, Shumac J, Enten G, Mangar D, Camporesi EM. Incidence and predictors of ischemic cerebrovascular stroke among patients on extracorporeal membrane oxygenation support. J Crit Care. 2016;32:48–51.
doi: 10.1016/j.jcrc.2015.11.009
Truby L, Mundy L, Kalesan B, Kirtane A, Colombo PC, Takeda K, et al. Contemporary Outcomes of Venoarterial Extracorporeal Membrane Oxygenation for Refractory Cardiogenic Shock at a Large Tertiary Care Center. ASAIO J. 2015;61:403–9.
doi: 10.1097/MAT.0000000000000225
Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors JJ, Culebras A, et al. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44:2064–89.
doi: 10.1161/STR.0b013e318296aeca
Mateen FJ, Muralidharan R, Shinohara RT, Parisi JE, Schears GJ, Wijdicks EFM. Neurological Injury in Adults Treated With Extracorporeal Membrane Oxygenation. Arch Neurol. 2011;68:1543–9.
doi: 10.1001/archneurol.2011.209
Kazmi SO, Sivakumar S, Karakitsos D, Alharthy A, Lazaridis C. Cerebral Pathophysiology in Extracorporeal Membrane Oxygenation: Pitfalls in Daily Clinical Management. Crit Care Res Pract. 2018;2018:3237810.
pubmed: 29744226
pmcid: 5878897
Lorusso R, Barili F, Mauro MD, Gelsomino S, Parise O, Rycus PT, et al. In-Hospital Neurologic Complications in Adult Patients Undergoing Venoarterial Extracorporeal Membrane Oxygenation: Results From the Extracorporeal Membrane Support Organization Registry. Crit Care Med. 2016;44:e964-972.
doi: 10.1097/CCM.0000000000001865
Saeed O, Jakobleff WA, Forest SJ, Chinnadurai T, Mellas N, Rangasamy S, et al. Hemolysis and Nonhemorrhagic Stroke During Venoarterial Extracorporeal Membrane Oxygenation. Ann Thorac Surg. 2019;108:756–63.
doi: 10.1016/j.athoracsur.2019.03.030
Mehta A, Ibsen LM. Neurologic complications and neurodevelopmental outcome with extracorporeal life support. World J Crit Care Med. 2013;2:40–7.
doi: 10.5492/wjccm.v2.i4.40
Werho DK, Pasquali SK, Yu S, Donohue J, Annich GM, Thiagarajan RR, et al. Epidemiology of Stroke in Pediatric Cardiac Surgical Patients Supported With Extracorporeal Membrane Oxygenation. Ann Thorac Surg. 2015;100:1751–7.
doi: 10.1016/j.athoracsur.2015.06.020
Rollins MD, Hubbard A, Zabrocki L, Barnhart DC, Bratton SL. Extracorporeal membrane oxygenation cannulation trends for pediatric respiratory failure and central nervous system injury. J Pediatr Surg. 2012;47:68–75.
doi: 10.1016/j.jpedsurg.2011.10.017
Pinto VL, Pruthi S, Westrick AC, Shannon CN, Bridges BC, Le TM. Brain Magnetic Resonance Imaging Findings in Pediatric Patients Post Extracorporeal Membrane Oxygenation. Asaio j. 2017;63:810–4.
doi: 10.1097/MAT.0000000000000580
Di Gennaro J, Farris R, McMullan D. 687: Risk of Stroke by Location of Arterial Cannulation and Age in Veno-Arterial ECMO. Critical Care Medicine. 2013;41
Bulas D, Glass P. Neonatal ECMO: neuroimaging and neurodevelopmental outcome. Semin Perinatol. 2005;29:58–65.
doi: 10.1053/j.semperi.2005.02.009