PMID- 35671442
OWN - NLM
STAT- MEDLINE
DCOM- 20221207
LR  - 20230203
IS  - 1538-943X (Electronic)
IS  - 1058-2916 (Print)
IS  - 1058-2916 (Linking)
VI  - 68
IP  - 12
DP  - 2022 Dec 1
TI  - Arterial Carbon Dioxide and Acute Brain Injury in Venoarterial Extracorporeal 
      Membrane Oxygenation.
PG  - 1501-1507
LID - 10.1097/MAT.0000000000001699 [doi]
AB  - Acute brain injury (ABI) occurs frequently in patients receiving venoarterial 
      extracorporeal membrane oxygenation (VA-ECMO). We examined the association 
      between peri-cannulation arterial carbon dioxide tension (PaCO 2 ) and ABI with 
      granular blood gas data. We retrospectively analyzed adult patients who underwent 
      VA-ECMO at a tertiary care center with standardized neuromonitoring. Pre- and 
      post-cannulation PaCO 2 were defined as the mean of all PaCO 2 values in the 12 
      hours before and after cannulation, respectively. Peri-cannulation PaCO 2 drop 
      (∆PaCO 2 ) equaled pre- minus post-cannulation PaCO 2 . ABI included intracranial 
      hemorrhage (ICH), ischemic stroke, hypoxic-ischemic brain injury, cerebral edema, 
      seizure, and brain death. Univariable logistic regression analysis was performed 
      for the presence of ABI. Out of 129 VA-ECMO patients (median age = 60, 63% male), 
      43 (33%) patients experienced ABI. Patients had a median of 11 (interquartile 
      range: 8-14) peri-cannulation PaCO 2 values. Comparing patients with and without 
      ABI, pre-cannulation (39 vs. 42 mm Hg; p = 0.38) and post-cannulation (37 vs. 
      36 mm Hg; p = 0.82) PaCO 2 were not different. However, higher pre-cannulation 
      PaCO 2 (odds ratio [OR] = 2.10; 95% confidence interval [CI] = 1.10-4.00; p = 
      0.02) and larger ∆PaCO 2 (OR = 2.69; 95% CI = 1.18-6.13; p = 0.02) were 
      associated with ICH. In conclusion, in a cohort with granular arterial blood gas 
      (ABG) data and a standardized neuromonitoring protocol, higher pre-cannulation 
      PaCO 2 and larger ∆PaCO 2 were associated with increased prevalence of ICH.
CI  - Copyright (c) ASAIO 2022.
FAU - Shou, Benjamin L
AU  - Shou BL
AUID- ORCID: 0000-0003-2825-3301
AD  - From the Division of Cardiac Surgery, Department of Surgery, Johns Hopkins 
      Hospital, Baltimore, Maryland.
FAU - Ong, Chin Siang
AU  - Ong CS
AD  - From the Division of Cardiac Surgery, Department of Surgery, Johns Hopkins 
      Hospital, Baltimore, Maryland.
FAU - Zhou, Alice L
AU  - Zhou AL
AUID- ORCID: 0000-0001-6593-3985
AD  - From the Division of Cardiac Surgery, Department of Surgery, Johns Hopkins 
      Hospital, Baltimore, Maryland.
FAU - Al-Kawaz, Mais N
AU  - Al-Kawaz MN
AD  - Division of Neurosciences Critical Care, Department of Neurology, Neurosurgery, 
      Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, 
      Maryland.
FAU - Etchill, Eric
AU  - Etchill E
AUID- ORCID: 0000-0002-5381-648
AD  - From the Division of Cardiac Surgery, Department of Surgery, Johns Hopkins 
      Hospital, Baltimore, Maryland.
FAU - Giuliano, Katherine
AU  - Giuliano K
AUID- ORCID: 0000-0003-2260-1854
AD  - From the Division of Cardiac Surgery, Department of Surgery, Johns Hopkins 
      Hospital, Baltimore, Maryland.
FAU - Dong, Jie
AU  - Dong J
AD  - From the Division of Cardiac Surgery, Department of Surgery, Johns Hopkins 
      Hospital, Baltimore, Maryland.
FAU - Bush, Errol
AU  - Bush E
AUID- ORCID: 0000-0003-1251-8467
AD  - Division of General Thoracic Surgery, Johns Hopkins Hospital, Baltimore, 
      Maryland.
FAU - Kim, Bo Soo
AU  - Kim BS
AUID- ORCID: 0000-0001-6277-7649
AD  - Division of Pulmonary and Critical Care Medicine, Johns Hopkins Hospital, 
      Baltimore, Maryland.
FAU - Choi, Chun Woo
AU  - Choi CW
AD  - From the Division of Cardiac Surgery, Department of Surgery, Johns Hopkins 
      Hospital, Baltimore, Maryland.
FAU - Whitman, Glenn
AU  - Whitman G
AD  - From the Division of Cardiac Surgery, Department of Surgery, Johns Hopkins 
      Hospital, Baltimore, Maryland.
FAU - Cho, Sung-Min
AU  - Cho SM
AD  - Division of Neurosciences Critical Care, Department of Neurology, Neurosurgery, 
      Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, 
      Maryland.
LA  - eng
GR  - K23 HL157610/HL/NHLBI NIH HHS/United States
GR  - L30 NS119233/NS/NINDS NIH HHS/United States
PT  - Journal Article
DEP - 20220314
PL  - United States
TA  - ASAIO J
JT  - ASAIO journal (American Society for Artificial Internal Organs : 1992)
JID - 9204109
RN  - 142M471B3J (Carbon Dioxide)
SB  - IM
MH  - Adult
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Female
MH  - *Extracorporeal Membrane Oxygenation/adverse effects/methods
MH  - Carbon Dioxide
MH  - Retrospective Studies
MH  - Femoral Artery
MH  - Intracranial Hemorrhages
MH  - *Brain Injuries/etiology/therapy
PMC - PMC9477972
MID - NIHMS1790909
COIS- Disclosure: B.L.S. received research funding from the Alpha Omega Alpha Honor 
      Medical Society during the conduct of this study. S-M.C. is supported by NHLBI 
      (1K23HL157610). The other authors have no conflicts of interest to report.
EDAT- 2022/06/08 06:00
MHDA- 2022/12/10 06:00
PMCR- 2022/12/08
CRDT- 2022/06/07 16:16
PHST- 2022/06/08 06:00 [pubmed]
PHST- 2022/12/10 06:00 [medline]
PHST- 2022/06/07 16:16 [entrez]
PHST- 2022/12/08 00:00 [pmc-release]
AID - 00002480-202212000-00015 [pii]
AID - 10.1097/MAT.0000000000001699 [doi]
PST - ppublish
SO  - ASAIO J. 2022 Dec 1;68(12):1501-1507. doi: 10.1097/MAT.0000000000001699. Epub 
      2022 Mar 14.