6533b7ddfe1ef96bd1275580
RESEARCH PRODUCT
Management of intracranial hemorrhage in adult patients on extracorporeal membrane oxygenation (ECMO): An observational cohort study.
Mikael BromanMikael BromanBo-michael BellanderBo-michael BellanderJiri BartekAlexander Fletcher-sandersjööAlexander Fletcher-sandersjööEric Peter ThelinEric Peter ThelinAdrian Elmi-terandersubject
MalePhysiologymedicine.medical_treatmentlcsh:MedicinePathology and Laboratory MedicineVascular MedicineDiagnostic RadiologyCohort Studies0302 clinical medicineAnimal CellsMedicine and Health Scienceslcsh:ScienceProspective cohort studyTomographyMultidisciplinaryGlasgow Outcome ScaleRadiology and ImagingDrugsMiddle AgedBody FluidsIntraventricular hemorrhageTreatment OutcomeBloodNeurologyAnesthesiaFemaleAnatomyCellular TypesIntracranial HemorrhagesResearch ArticleHydrocephalusAdultPlateletsSubarachnoid hemorrhageConsciousnessImaging TechniquesCognitive NeuroscienceHemorrhageNeuroimagingSurgical and Invasive Medical ProceduresPatient AdvocacyResearch and Analysis Methods03 medical and health sciencesYoung AdultExtracorporeal Membrane OxygenationSigns and SymptomsMidline shiftDiagnostic MedicinemedicineExtracorporeal membrane oxygenationHumanscardiovascular diseasesRetrospective StudiesPharmacologyBlood Cellsbusiness.industryHeparinlcsh:RBiology and Life Sciences030208 emergency & critical care medicineRetrospective cohort studyCell Biologymedicine.diseaseHydrocephalusnervous system diseasesComputed Axial TomographyHealth CareCognitive Sciencelcsh:Qbusiness030217 neurology & neurosurgeryNeurosciencedescription
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.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2017-10-12 | PloS one |