J Clin Neurol.  2015 Oct;11(4):383-389. 10.3988/jcn.2015.11.4.383.

Neurologic Complications of Extracorporeal Membrane Oxygenation

• Nasr DM
• Rabinstein AA

• KMID: 2179759
• DOI: http://doi.org/10.3988/jcn.2015.11.4.383

Abstract

BACKGROUND AND PURPOSE
The rate and outcomes of neurologic complications of patients receiving extracorporeal membrane oxygenation (ECMO) are poorly understood. The purpose of this study was to identify these parameters in ECMO patients.
METHODS
All patients receiving ECMO were selected from the Nationwide Inpatient Sample between 2001-2011. The rate and outcomes of neurologic complications [acute ischemic stroke, intracranial hemorrhage (ICH), and seizures] among these patients was determined. Discharge status, mortality, length of stay, and hospitalization costs were compared between patients with and without neurologic complications using chi-squared tests for categorical variables and Student's t-test for continuous variables.
RESULTS
In total, 23,951 patients were included in this study, of which 2,604 (10.9%) suffered neurologic complications of seizure (4.1%), stroke (4.1%), or ICH (3.6%). When compared to patients without neurologic complications, acute ischemic stroke patients had significantly higher rates of discharge to a long-term facility (12.2% vs. 6.8%, p<0.0001) and a significantly longer mean length of stay (41.6 days vs. 31.9 days, p<0.0001). ICH patients had significantly higher rates of discharge to a long-term facility (9.5% vs. 6.8%, p=0.007), significantly higher mortality rates (59.7% vs. 50.0%, p<0.0001), and a significantly longer mean length of stay (41.8 days vs. 31.9 days) compared to patients without neurologic complications. These outcomes did not differ significantly between seizure patients and patients without neurologic complications.
CONCLUSIONS
Given the increasing utilization of ECMO and the high costs and poor outcomes associated with neurologic complications, more research is needed to help determine the best way to prevent these sequelae in this patient population.

Keyword

extracorporeal membrane oxygenation; stroke; neurology/neurologic (deficits, disease, injury)

MeSH Terms

Extracorporeal Membrane Oxygenation*
Hospitalization
Humans
Inpatients
Intracranial Hemorrhages
Length of Stay
Mortality
Seizures
Stroke

Figure

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  Fig. 1 Number of patients treated with extracorporeal membrane oxygenation (ECMO) during the period 2001-2011. Graphical representation of ECMO utilization in the United States Nationwide Inpatient Sample from the period 2001-2011. ECMO utilization increased from 1,613 patients in 2001 to 3,597 patients in 2011. Utilization in adults increased from 309 patients in 2001 to 2004 patients in 2011; these data for the pediatric population are 1,027 and 1,434 patients, respectively.

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