Cerebrovascular Complications of COVID-19 on Venovenous Extracorporeal Membrane Oxygenation.
- 2023
Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006
CONCLUSIONS: Our study highlights the association of obesity and pre-ECMO vasopressor use with the development of stroke in COVID-19 patients on venovenous ECMO. Also, the importance of relative decrease in Paco2 and moderate hyperoxia within 48 hours after ECMO initiation were additional risk factors. Copyright 2023 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved. DESIGN: We analyzed prospectively collected observational data, using univariable and multivariable survival modeling to identify risk factors for stroke. Cox proportional hazards and Fine-Gray models were used, with death and discharge treated as competing risks. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Five hundred ninety-five patients (median age [interquartile range], 51 yr [42-59 yr]; male: 70.8%) had venovenous ECMO support. Forty-three patients (7.2%) suffered strokes, 83.7% of which were hemorrhagic. In multivariable survival analysis, obesity (adjusted hazard ratio [aHR], 2.19; 95% CI, 1.05-4.59) and use of vasopressors before ECMO (aHR, 2.37; 95% CI, 1.08-5.22) were associated with an increased risk of stroke. Forty-eight-hour post-ECMO Paco2-pre-ECMO Paco2/pre-ECMO Paco2 (relative DELTAPaco2) of negative 26% and 48-hour post-ECMO Pao2-pre-ECMO Pao2/pre-ECMO Pao2 (relative DELTAPao2) of positive 24% at 48 hours of ECMO initiation were observed in stroke patients in comparison to relative DELTAPaco2 of negative 17% and relative DELTAPao2 of positive 7% in the nonstroke group. Patients with acute stroke had a 79% in-hospital mortality compared with 45% mortality for stroke-free patients. OBJECTIVES: Evidence of cerebrovascular complications in COVID-19 requiring venovenous extracorporeal membrane oxygenation (ECMO) is limited. Our study aims to characterize the prevalence and risk factors of stroke secondary to COVID-19 in patients on venovenous ECMO. PATIENTS: Adult COVID-19 patients who were supported by venovenous ECMO. SETTING: Three hundred eighty institutions in 53 countries in the COVID-19 Critical Care Consortium (COVID Critical) registry.