Pneumologie 2023; 77(S 01): S99-S100
DOI: 10.1055/s-0043-1761111
Abstracts

Association of early changes in carbon dioxide with acute brain injury in adult patients with extracorporeal membrane oxygenation: a ten-year retrospective study in a German tertiary care hospital

Authors

  • K Roedl

    1   Universitätsklinikum Hamburg-Eppendorf; Universitätsklinikum Hamburg-Eppendorf; Klinik für Intensivmedizin

  • M Fischer

    2   Klinik für Intensivmedizin – Uke; Universitätsklinikum Hamburg-Eppendorf; Klinik für Intensivmedizin

  • Y Yu

    3   Universitätsklinikum Hamburg-Eppendorf; Universitätsklinikum Hamburg-Eppendorf; Klinik für Anästhesiologie

  • I Lettow

    4   Universitätsklinikum Hamburg-Eppendorf; Universitätsklinikum Hamburg-Eppendorf; Klinik für Neurologie

  • D Jarczak

    5   Klinik für Intensivmedizin; Universitätsklinikum Hamburg-Eppendorf; Klinik für Intensivmedizin

  • H Pinnschmidt

    6   Universitätsklinikum Hamburg-Eppendorf; Universitätsklinikum Hamburg-Eppendorf; Institut für Medizinische Biometrie und Epidemiologie

  • A Bernhardt

    7   Universitätsklinikum Hamburg-Eppendorf; Universitäres Herzzentrum; Klinik und Poliklinik für Herz- und Gefäßchirurgie

  • D Frings

    1   Universitätsklinikum Hamburg-Eppendorf; Universitätsklinikum Hamburg-Eppendorf; Klinik für Intensivmedizin

  • B Sensen

    1   Universitätsklinikum Hamburg-Eppendorf; Universitätsklinikum Hamburg-Eppendorf; Klinik für Intensivmedizin

  • S Kluge

    8   Universitätsklinikum Eppendorf
Further Information
Also available at
 
 

Background Acute brain injury is one of the most devastating complications of extracorporeal membrane oxygenation (ECMO) and is associated with high mortality. We aimed to identify factors associated with intracranial hemorrhage or ischemic stroke during ECMO for circulatory or respiratory support.

Methods Single-center retrospective study in a tertiary care ECMO center. Patients who required ECMO for circulatory or respiratory failure between January 2011 and April 2021 were included. Only patients for whom a cerebral computed tomography (cCT) scan during ECMO support or within 72 hours after ECMO removal was available, were considered for analysis. We performed binary logistic regression analyses with the relative change of arterial carbon dioxide (RelΔPaCO2) and factors that were considered clinically relevant as independent variables.

Results A total number of 618 patients required ECMO during the study period and had a cCT (ECMO for respiratory support: n=295; ECMO for circulatory support: n=207; extracorporeal cardiopulmonary resuscitation [eCPR]: n=116). Intracranial hemorrhage occurred more frequently in patients with respiratory failure (19.0%) compared with patients with circulatory failure (8.2%) and eCPR (4.3%). Conversely, the incidence of ischemic stroke and hypoxic-ischemic brain injury was higher in patients with circulatory failure (20.3% and 7.7%) and eCPR (17.2% and 38.8%) compared with patients with respiratory failure (4.7% and 2.4%). The indication for ECMO (OR 2.418 [95% CI: 1.128;5.187], p=0.023) and antithrombin III (OR 1.018 [95% CI: 1.004;1.031], p=0.009) were associated with intracranial hemorrhage. Carboxyhemoglobin (OR 1.320 [95% CI: 1.073;1.624], p=0.009) and the indication for ECMO (OR 0.023 [95% CI: 0.083;0.498], p<0.001) were associated with ischemic stroke. There was no significant association between RelΔPaCO2 and intracranial hemorrhage or cerebral ischemia.

Conclusion Our findings suggest that a reduction in PaCO2 early after ECMO initiation is not associated with acute brain injury. More studies are urgently needed to identify risk factors for brain injury during ECMO support and to guide specific treatment.


Publication History

Article published online:
09 March 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag
Rüdigerstraße 14, 70469 Stuttgart, Germany