Journal article
Cerebrovascular Complications of COVID19 on Venovenous Extracorporeal Membrane Oxygenation
Critical care medicine, Vol.51(8), pp.1043-1053
08/2023
DOI: 10.1097/CCM.0000000000005861
PMCID: PMC10335601
PMID: 37010526
Abstract
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.
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.
Setting: Three hundred eighty institutions in 53 countries in the COVID-19 Critical Care Consortium (COVID Critical) registry.
Patients: Adult COVID-19 patients who were supported by venovenous ECMO.
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 Pa co2 -pre-ECMO Pa co2 /pre-ECMO Pa co2 (relative ΔPa co2 ) of negative 26% and 48-hour post-ECMO Pa o2 -pre-ECMO Pa o2 /pre-ECMO Pa o2 (relative ΔPa o2 ) of positive 24% at 48 hours of ECMO initiation were observed in stroke patients in comparison to relative ΔPa co2 of negative 17% and relative ΔPa o2 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.
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 Pa co2 and moderate hyperoxia within 48 hours after ECMO initiation were additional risk factors.
Details
- Title: Subtitle
- Cerebrovascular Complications of COVID19 on Venovenous Extracorporeal Membrane Oxygenation
- Creators
- Akram M. ZaaqoqMatthew J. Griffee - University of UtahThu-Lan KellyJonathon P Fanning - The University of QueenslandSilver HeinsarJacky Y Suen - The University of QueenslandSilvia MarianiGianluigi Li Bassi - Wesley Research InstituteJeffrey P Jacobs - University of South FloridaNicole White - Queensland University of TechnologyCOVID-19 Critical Care Consortium (COVID Critical)
- Contributors
- Lovkesh Arora (Contributor) - University of Iowa, Anesthesia
- Resource Type
- Journal article
- Publication Details
- Critical care medicine, Vol.51(8), pp.1043-1053
- DOI
- 10.1097/CCM.0000000000005861
- PMID
- 37010526
- PMCID
- PMC10335601
- NLM abbreviation
- Crit Care Med
- ISSN
- 0090-3493
- Language
- English
- Date published
- 08/2023
- Academic Unit
- Anesthesia
- Record Identifier
- 9984557058002771
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