PMID- 35213724
OWN - NLM
STAT- MEDLINE
DCOM- 20220609
LR  - 20220609
IS  - 2048-8734 (Electronic)
IS  - 2048-8726 (Linking)
VI  - 11
IP  - 4
DP  - 2022 Jun 7
TI  - Intracranial haemorrhage in adult patients on venoarterial extracorporeal 
      membrane oxygenation.
PG  - 303-311
LID - 10.1093/ehjacc/zuac018 [doi]
AB  - AIMS: Intracranial haemorrhage (ICH) is one of the most serious complications of 
      adult patients treated with venoarterial extracorporeal membrane oxygenation 
      (VA-ECMO) and is associated with increased morbidity and mortality. However, the 
      prevalence and risk factors of ICH in this cohort are still insufficiently 
      understood. We hypothesized that a considerable proportion of patients undergoing 
      VA-ECMO support suffer from ICH and that specific risk factors are associated 
      with the occurrence of ICH. Therefore, the purpose of this study was to further 
      investigate the prevalence and associated mortality as well as to identify risk 
      factors for ICH in VA-ECMO patients. METHODS AND RESULTS: We conducted a 
      retrospective multicentre study including adult patients (>/=18 years) treated with 
      VA-ECMO in cardiac intensive care units (ICUs) at five German clinical sites 
      between January 2016 and March 2020, excluding patients with ICH upon admission. 
      Differences in baseline characteristics and clinical outcome between VA-ECMO 
      patients with and without ICH were analysed and risk factors for ICH were 
      identified. Among the 598 patients included, 70/598 (12%) developed ICH during 
      VA-ECMO treatment. In-hospital mortality in patients with ICH was 57/70 (81%) and 
      1-month mortality 60/70 (86%), compared to 332/528 (63%) (P = 0.002) and 340/528 
      (64%) (P < 0.001), respectively, in patients without ICH. Intracranial 
      haemorrhage was positively associated with diabetes mellitus [odds ratio (OR) 2, 
      95% confidence interval (CI) 1.11-3.56; P = 0.020] and lactate (per mmol/L) (OR 
      1.06, 95% CI 1.01-1.11; P = 0.020), and negatively associated with platelet count 
      (per 100 G/L) (OR 0.32, 95% CI 0.15-0.59; P = 0.001) and fibrinogen (per 100 
      mg/dL) (OR 0.64, 95% CI 0.49-0.83; P < 0.001). CONCLUSION: Intracranial 
      haemorrhage was associated with a significantly higher mortality rate. Diabetes 
      mellitus and lactate were positively, platelet count, and fibrinogen level 
      negatively associated with the occurrence of ICH. Thus, platelet count and 
      fibrinogen level were revealed as potentially modifiable, independent risk 
      factors for ICH. The findings address an area with limited data, provide 
      information about risk factors and the epidemiology of ICH, and may be a starting 
      point for further investigations to develop effective strategies to prevent and 
      treat ICH.
CI  - Published on behalf of the European Society of Cardiology. All rights reserved. (c) 
      The Author(s) 2022. For permissions, please email: journals.permissions@oup.com.
FAU - Lusebrink, Enzo
AU  - Lusebrink E
AUID- ORCID: 0000-0002-3214-5672
AD  - Cardiac Intensive Care Unit, Medizinische Klinik und Poliklinik I, Klinikum der 
      Universitat Munchen, Marchioninistrasse 15, 81377 Munich, Germany.
AD  - DZHK (German Center for Cardiovascular Research), Partner Site, Munich Heart 
      Alliance, Munich, Germany.
FAU - Zimmer, Sebastian
AU  - Zimmer S
AUID- ORCID: 0000-0002-1531-2088
AD  - Medizinische Klinik und Poliklinik II, Universitatsklinikum Bonn, Bonn, Germany.
FAU - Schrage, Benedikt
AU  - Schrage B
AD  - Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, 
      Germany.
AD  - DZHK (German Center for Cardiovascular Research), Partner Site 
      Hamburg/Kiel/Lubeck, Hamburg, Germany.
FAU - Dabboura, Salim
AU  - Dabboura S
AD  - Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, 
      Germany.
AD  - DZHK (German Center for Cardiovascular Research), Partner Site 
      Hamburg/Kiel/Lubeck, Hamburg, Germany.
FAU - Majunke, Nicolas
AU  - Majunke N
AD  - Heart Center Leipzig at University of Leipzig, Department of Internal 
      Medicine/Cardiology and Leipzig Heart Institute, Leipzig, Germany.
FAU - Scherer, Clemens
AU  - Scherer C
AUID- ORCID: 0000-0003-2816-6793
AD  - Cardiac Intensive Care Unit, Medizinische Klinik und Poliklinik I, Klinikum der 
      Universitat Munchen, Marchioninistrasse 15, 81377 Munich, Germany.
AD  - DZHK (German Center for Cardiovascular Research), Partner Site, Munich Heart 
      Alliance, Munich, Germany.
FAU - Aksoy, Adem
AU  - Aksoy A
AD  - Medizinische Klinik und Poliklinik II, Universitatsklinikum Bonn, Bonn, Germany.
FAU - Krogmann, Alexander
AU  - Krogmann A
AD  - Medizinische Klinik und Poliklinik II, Universitatsklinikum Bonn, Bonn, Germany.
FAU - Hoffmann, Sabine
AU  - Hoffmann S
AD  - Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig 
      Maximilians Universitat Munchen, Munich, Germany.
FAU - Szczanowicz, Lukasz
AU  - Szczanowicz L
AD  - Heart Center Leipzig at University of Leipzig, Department of Internal 
      Medicine/Cardiology and Leipzig Heart Institute, Leipzig, Germany.
FAU - Binzenhofer, Leonhard
AU  - Binzenhofer L
AD  - Cardiac Intensive Care Unit, Medizinische Klinik und Poliklinik I, Klinikum der 
      Universitat Munchen, Marchioninistrasse 15, 81377 Munich, Germany.
AD  - DZHK (German Center for Cardiovascular Research), Partner Site, Munich Heart 
      Alliance, Munich, Germany.
FAU - Peterss, Sven
AU  - Peterss S
AUID- ORCID: 0000-0003-1880-152X
AD  - Herzchirurgische Klinik und Poliklinik, Klinikum der Universitat Munchen, Munich, 
      Germany.
FAU - Kuhn, Christian
AU  - Kuhn C
AD  - Klinik fur Herz-, Thorax-, Transplantations- und Gefasschirurgie, Medizinischen 
      Hochschule Hannover, Hannover, Germany.
FAU - Hagl, Christian
AU  - Hagl C
AD  - Herzchirurgische Klinik und Poliklinik, Klinikum der Universitat Munchen, Munich, 
      Germany.
FAU - Massberg, Steffen
AU  - Massberg S
AUID- ORCID: 0000-0001-7387-3986
AD  - Cardiac Intensive Care Unit, Medizinische Klinik und Poliklinik I, Klinikum der 
      Universitat Munchen, Marchioninistrasse 15, 81377 Munich, Germany.
AD  - DZHK (German Center for Cardiovascular Research), Partner Site, Munich Heart 
      Alliance, Munich, Germany.
FAU - Schafer, Andreas
AU  - Schafer A
AUID- ORCID: 0000-0003-3206-6162
AD  - Klinik fur Kardiologie und Angiologie, Medizinische Hochschule Hannover, 
      Hannover, Germany.
FAU - Thiele, Holger
AU  - Thiele H
AUID- ORCID: 0000-0002-0169-998X
AD  - Heart Center Leipzig at University of Leipzig, Department of Internal 
      Medicine/Cardiology and Leipzig Heart Institute, Leipzig, Germany.
FAU - Westermann, Dirk
AU  - Westermann D
AUID- ORCID: 0000-0002-7542-1956
AD  - Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, 
      Germany.
AD  - DZHK (German Center for Cardiovascular Research), Partner Site 
      Hamburg/Kiel/Lubeck, Hamburg, Germany.
FAU - Orban, Martin
AU  - Orban M
AUID- ORCID: 0000-0001-9830-1941
AD  - Cardiac Intensive Care Unit, Medizinische Klinik und Poliklinik I, Klinikum der 
      Universitat Munchen, Marchioninistrasse 15, 81377 Munich, Germany.
AD  - DZHK (German Center for Cardiovascular Research), Partner Site, Munich Heart 
      Alliance, Munich, Germany.
CN  - ICH-VA-ECMO Investigator Group
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PL  - England
TA  - Eur Heart J Acute Cardiovasc Care
JT  - European heart journal. Acute cardiovascular care
JID - 101591369
RN  - 0 (Lactates)
RN  - 9001-32-5 (Fibrinogen)
SB  - IM
MH  - Adult
MH  - *Extracorporeal Membrane Oxygenation/methods
MH  - Fibrinogen
MH  - Humans
MH  - Intracranial Hemorrhages/epidemiology/etiology
MH  - Lactates
MH  - Retrospective Studies
MH  - Shock, Cardiogenic/etiology
OTO - NOTNLM
OT  - Cardiogenic shock
OT  - Intracranial haemorrhage
OT  - VA-ECMO
FIR - Kupka, Danny
IR  - Kupka D
FIR - Schmid, Teresa
IR  - Schmid T
FIR - Mauthe, Katharina
IR  - Mauthe K
FIR - Joskowiak, Dominik
IR  - Joskowiak D
FIR - Kaab, Stefan
IR  - Kaab S
FIR - Petzold, Tobias
IR  - Petzold T
FIR - Orban, Mathias
IR  - Orban M
FIR - Parhofer, Klaus G
IR  - Parhofer KG
EDAT- 2022/02/26 06:00
MHDA- 2022/06/10 06:00
CRDT- 2022/02/25 17:16
PHST- 2021/12/05 00:00 [received]
PHST- 2022/01/15 00:00 [revised]
PHST- 2022/01/30 00:00 [accepted]
PHST- 2022/02/26 06:00 [pubmed]
PHST- 2022/06/10 06:00 [medline]
PHST- 2022/02/25 17:16 [entrez]
AID - 6537069 [pii]
AID - 10.1093/ehjacc/zuac018 [doi]
PST - ppublish
SO  - Eur Heart J Acute Cardiovasc Care. 2022 Jun 7;11(4):303-311. doi: 
      10.1093/ehjacc/zuac018.