The following is a summary of “Epidemiology of ischemic stroke and hemorrhagic stroke in venoarterial extracorporeal membrane oxygenation,” published in the November 2023 issue of Critical Care by Hwang et al.

Venoarterial extracorporeal membrane oxygenation (V-A ECMO) is a lifesaving support for cardiopulmonary failure, but complications such as stroke may occur.

Researchers started a retrospective study to investigate trends and associations of stroke incidence and mortality in ECMO patients, including risk factors and the effects of annual case volumes of ECMO centers.

They analyzed data from the Extracorporeal Life Support Organization (ELSO) registry, encompassing adult V-A ECMO patients from 534 international centers (2012 to 2021, excluding extracorporeal cardiopulmonary resuscitation). Temporal trends were analyzed for stroke incidence and mortality. Used univariate testing, multivariable regression, and survival analysis to assess associations of stroke, 90-day mortality, and the impact of annual center volume.

The results showed 33,041 patients, 20,297 had available mortality data, and 12,327 were part of the logistic regression. From 2012 to 2021, there was a significant increase in ischemic stroke incidence (P<0.0001), stable hemorrhagic stroke incidence, and a notable decrease in overall 90-day mortality (P<0.0001). Higher 24-hour PaO₂ and a greater decline between pre-ECMO PaCO₂ and post-cannulation 24-hour PaCO₂ were associated with increased ischemic stroke incidence, with no observed association with annual case volume. Both ischemic and hemorrhagic strokes were correlated with elevated 90-day mortality (both P<0.0001), whereas higher annual case volume correlated with lower 90-day mortality (P=0.001). The risk of death was most pronounced in the initial days of V-A ECMO.

Investigators concluded that between 2012 and 2021, 90-day mortality decreased in V-A ECMO patients, but ischemic stroke incidence increased.

Source: ccforum.biomedcentral.com/articles/10.1186/s13054-023-04707-z