Management of intracranial hemorrhage in adult patients on extracorporeal membrane oxygenation (ECMO): An observational cohort study.

Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE

Original Publication: San Francisco, CA : Public Library of Science

Extracorporeal Membrane Oxygenation/*adverse effects ; Intracranial Hemorrhages/*therapy; Adult ; Cohort Studies ; Female ; Humans ; Intracranial Hemorrhages/etiology ; Intracranial Hemorrhages/mortality ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Young Adult

Background: Intracranial hemorrhage (ICH) is a common complication in adults treated with extracorporeal membrane oxygenation (ECMO). The aim of this study was to identify predictors of outcome and investigate intervention strategies following ICH development in ECMO-treated adult patients.
Methods: We conducted a retrospective review of adult patients (≥18 years) who developed an ICH during ECMO treatment at the Karolinska University Hospital (Stockholm, Sweden) between September 2005 and May 2017. Outcome was assessed by 30-day mortality and Glasgow Outcome Scale (GOS) after 6 months. The statistical analysis was supplemented by a case series of patients who were surgically treated for an ICH.
Results: Sixty-five patients developed an ICH during ECMO treatment. 30-day mortality was 74% (n = 48), and was significantly associated with low level of consciousness at ICH diagnosis (p = 0.036), presence of intraparenchymal hematoma (IPH) (p = 0.049), IPH volume (p = 0.002), presence of intraventricular hemorrhage (p = 0.001), subarachnoid hemorrhage Fisher grade (p<0.001), hydrocephalus (p<0.001), midline shift (p = 0.026) and absent basal cisterns (p<0.001). Among the 30-day survivors (n = 17), 63% (n = 10) had favorable neurological outcome (GOS 4-5) after six months. Five patients were surgically treated for their ICH, some with dire hemorrhagic consequences, however one patient made a complete recovery.
Conclusions: ICH in adult ECMO patients is associated with a high mortality rate. Outcome predictors can help to identify patients where ICH treatment is indicated. Treating a patient with an ICH during ECMO represents an intricate balance between pro- and anticoagulatory demands. Furthermore, surgical treatment is associated with several risks but may be indicated in life-threatening lesions. Prospective studies are warranted.

Intensive Care Med. 2016 May;42(5):897-907. (PMID: 27007107)
Ann Intensive Care. 2016 Dec;6(1):97. (PMID: 27714705)
PLoS Med. 2017 Aug 3;14 (8):e1002368. (PMID: 28771476)
Acad Radiol. 2007 Jan;14 (1):62-71. (PMID: 17178367)
Acta Neurochir (Wien). 2005 Sep;147(9):993-6; discussion 996. (PMID: 16021388)
Eur J Cardiothorac Surg. 1999 Apr;15(4):508-14. (PMID: 10371130)
J Clin Neurol. 2015 Oct;11(4):383-9. (PMID: 26320848)
Surg Neurol Int. 2016 Aug 01;7(Suppl 18):S510-7. (PMID: 27583176)
ASAIO J. 2015 Jan-Feb;61(1):31-6. (PMID: 25303799)
Crit Care. 2013 Apr 18;17(2):R73. (PMID: 23594433)
Neurosurgery. 2005 Dec;57(6):1173-82; discussion 1173-82. (PMID: 16331165)
Lancet Neurol. 2017 Aug;16(8):630-647. (PMID: 28721927)
Crit Care. 2015 Jul 09;19:278. (PMID: 26160033)
J Chronic Dis. 1987;40(5):373-83. (PMID: 3558716)
Neurosurgery. 1992 Oct;31(4):678-84; discussion 684-5. (PMID: 1407453)
Artif Organs. 2002 Nov;26(11):902-8. (PMID: 12406140)
Crit Care Med. 2017 Oct;45(10 ):1642-1649. (PMID: 28727576)
J Neurosurg Anesthesiol. 2011 Jan;23(1):30-4. (PMID: 20706140)
ASAIO J. 2016 Sep-Oct;62(5):634-6. (PMID: 26978708)
Neurosurgery. 1980 Jan;6(1):1-9. (PMID: 7354892)
Stroke. 2001 Apr;32(4):891-7. (PMID: 11283388)
BMC Res Notes. 2015 Nov 18;8:686. (PMID: 26581610)
J Neurotrauma. 2007 Nov;24(11):1699-706. (PMID: 18001200)
Acta Neurochir (Wien). 1988;91(1-2):12-20. (PMID: 3394542)
Semin Thorac Cardiovasc Surg. 2015 Summer;27(2):81-8. (PMID: 26686427)
J Intensive Care. 2017 May 22;5:27. (PMID: 28546860)
Neurocrit Care. 2011 Feb;14(1):134-43. (PMID: 20652445)
Crit Care. 2015 Aug 31;19:309. (PMID: 26330064)
Lancet. 1975 Mar 1;1(7905):480-4. (PMID: 46957)
Front Pediatr. 2016 Jun 13;4:63. (PMID: 27379221)
J Thorac Dis. 2015 Jul;7(7):E166-76. (PMID: 26380745)
J Neurosurg Anesthesiol. 2013 Oct;25(4):372-85. (PMID: 23715045)
Stroke. 1996 Aug;27(8):1304-5. (PMID: 8711791)

Date Created: 20171222 Date Completed: 20180116 Latest Revision: 20181113

20231215

PMC5739492

10.1371/journal.pone.0190365

29267368