Brain injury during venovenous extracorporeal membrane oxygenation

被引:201
作者
Luyt, Charles-Edouard [1 ,2 ]
Brechot, Nicolas [1 ,2 ]
Demondion, Pierre [3 ]
Jovanovic, Tamara
Hekimian, Guillaume [1 ,2 ]
Lebreton, Guillaume [3 ]
Nieszkowska, Ania [1 ,2 ]
Schmidt, Matthieu [1 ,2 ]
Trouillet, Jean-Louis [1 ,2 ]
Leprince, Pascal [3 ]
Chastre, Jean [1 ,2 ]
Combes, Alain [1 ,2 ]
机构
[1] Grp Hosp Pitie Salpetriere, AP HP, ICAN, Inst Cardiol,Serv Reanimat, 47-83 Blvd Hop, F-75651 Paris 13, France
[2] Univ Paris 06, Sorbonne Univ, INSERM, ICAN Inst Cardiometab & Nutr,UMRS 1166, Paris, France
[3] Grp Hosp Pitie Salpetriere, AP HP, Inst Cardiol, Serv Chirurg Thorac & Cardiovasc, 47-83 Blvd Hop, F-75651 Paris 13, France
关键词
Extracorporeal membrane oxygenation; Acute lung injury; Intracranial brain hemorrhage; Cerebral stroke; Hypercapnia; RESPIRATORY-DISTRESS-SYNDROME; 2009 INFLUENZA A(H1N1); ADULT PATIENTS; LIFE-SUPPORT; FAILURE; ECMO; VENTILATION; EXPERIENCE; ARDS;
D O I
10.1007/s00134-016-4318-3
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
The frequency of neurological events and their impact on patients receiving venovenous extracorporeal membrane oxygenation (VV-ECMO) are unknown. We therefore study the epidemiology, risk factors, and impact of cerebral complications occurring in VV-ECMO patients. Observational study conducted in a tertiary referral center (2006-2012) on patients developing a neurological complication (ischemic stroke or intracranial bleeding) while on VV-ECMO versus those who did not, and a systematic review on this topic. Among 135 consecutive patients who had received VV-ECMO, 18 (15 assessable) developed cerebral complications on ECMO: cerebral bleeding in 10 (7.5 %), ischemic stroke in 3 (2 %), or diffuse microbleeds in 2 (2 %), occurring after respective medians (IQR) of 3 (1-11), 21 (10-26), and 36 (8-63) days post-ECMO onset. Intracranial bleeding was independently associated with renal failure at intensive care unit admission and rapid PaCO2 decrease at ECMO initiation, but not with age, comorbidities, or hemostasis disorders. Seven (70 %) patients with intracranial bleeding and one (33 %) with ischemic stroke died versus 40 % of patients without neurological event. A systematic review found comparable intracranial bleeding rates (5 %). Neurological events occurred frequently in patients on VV-ECMO. Intracranial bleeding, the most frequent, occurred early and was associated with higher mortality. Because it was independently associated with rapid hypercapnia decrease, the latter should be avoided at ECMO onset, but its exact role remains to be determined. These findings may have major implications for the care of patients requiring VV-ECMO.
引用
收藏
页码:897 / 907
页数:11
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