Epidemiology of ischemic stroke and hemorrhagic stroke in venoarterial extracorporeal membrane oxygenation.
Mortality
Stroke
Trend
Venoarterial ECMO
Journal
Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902
Informations de publication
Date de publication:
09 11 2023
09 11 2023
Historique:
received:
24
07
2023
accepted:
23
10
2023
medline:
13
11
2023
pubmed:
10
11
2023
entrez:
10
11
2023
Statut:
epublish
Résumé
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. 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. 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 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.
Sections du résumé
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
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.
Identifiants
pubmed: 37946237
doi: 10.1186/s13054-023-04707-z
pii: 10.1186/s13054-023-04707-z
pmc: PMC10633935
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
433Subventions
Organisme : 1K23HL157610
ID : NHLBI
Commentaires et corrections
Type : UpdateOf
Informations de copyright
© 2023. The Author(s).
Références
Artif Organs. 2010 Feb;34(2):E59-64
pubmed: 20420591
Ann Intensive Care. 2018 Dec 20;8(1):129
pubmed: 30570687
Crit Care Med. 2020 Jul;48(7):977-984
pubmed: 32574466
J Thorac Cardiovasc Surg. 2023 Jun;165(6):2104-2110.e1
pubmed: 34865837
Am J Respir Crit Care Med. 2015 Apr 15;191(8):894-901
pubmed: 25695688
J Clin Neurol. 2015 Oct;11(4):383-9
pubmed: 26320848
ASAIO J. 2017 Jan/Feb;63(1):60-67
pubmed: 27984321
Acute Med Surg. 2020 Feb 12;7(1):e486
pubmed: 32076555
Ann Thorac Surg. 2017 Jul;104(1):62-69
pubmed: 28131429
Crit Care Med. 2016 Oct;44(10):e964-72
pubmed: 27340754
JACC Heart Fail. 2016 Sep;4(9):698-708
pubmed: 27179833
ASAIO J. 2019 Sep/Oct;65(7):674-677
pubmed: 30398981
Am Heart J. 2023 Jul;261:109-123
pubmed: 37031832
Crit Care Med. 2014 Mar;42(3):512-9
pubmed: 24164955
Ann Thorac Surg. 2019 Sep;108(3):756-763
pubmed: 30980824
Crit Care Explor. 2022 Jul 25;4(7):e0733
pubmed: 35923595
Crit Care Med. 2020 Oct;48(10):e897-e905
pubmed: 32931195
Circ J. 2020 Nov 25;84(12):2205-2211
pubmed: 33041291
Crit Care Med. 2021 Jan 1;49(1):91-101
pubmed: 33148951
J Heart Lung Transplant. 2023 Apr;42(4):503-511
pubmed: 36435686