Acute Brain Injury in Postcardiotomy Shock Treated With Venoarterial Extracorporeal Membrane Oxygenation

摘要

Objective: Acute brain injury (ABI) is common in venoarterial extracorporeal membrane oxygenation (VA-ECMO). One of the most common indications for use of VA-ECMO is postcardiotomy shock (PCS). The authors aimed to characterize the prevalence of ABI and its association with outcomes in this population. Design: prospective observational. Setting: Single-center tertiary care university hospital. Participants: Fifty-two consecutive patients treated for PCS with VA-ECMO from November 2017 to March 2020. Interventions: None. Measurements and Main Results: The median age of patients was 64 (interquartile range 44-84), 62 were male. Of 52 PCS patients treated with extracorporeal membrane oxygenation, 38 (n = 20) experienced acute brain injury. Ischemic stroke was the most common (n = 13, 25). Patients with central versus peripheral cannulation experienced more ischemic and hemorrhagic strokes (8 v 38, p = 0.04). Patients with intracardiac thrombus experienced more brain injury (n = 4, 8 p = 0.02). The in-hospital mortality in patients with brain injury was 90 (n = 18/20) compared to 78 (n = 25/32) in patients without brain injury. Conclusions: ABI is common in postcardiotomy VA-ECMO and associated with worse outcome. Patients with central recanalization experienced the majority of acute strokes. Intracardiac thrombus was significantly associated with acute brain injury. (C) 2021 Elsevier Inc. All rights reserved.