PMID- 37577645
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240216
DP  - 2023 Jul 31
TI  - Epidemiology of Ischemic Stroke and Hemorrhagic Stroke in Venoarterial 
      Extracorporeal Membrane Oxygenation.
LID - rs.3.rs-3200908 [pii]
LID - 10.21203/rs.3.rs-3200908/v1 [doi]
AB  - BACKGROUND: While venoarterial extracorporeal membrane oxygenation (VA-ECMO) 
      provides lifesaving support for cardiopulmonary failure, complications may arise 
      that increase mortality, with few studies focusing on ischemic/hemorrhagic 
      stroke. We aimed to determine the trends of stroke incidence and mortality, 
      associations with each other, and associations with total case volume at each 
      Extracorporeal Life Support Organization (ELSO) center. METHODS: Retrospective 
      analysis of ELSO registry, including adult VA-ECMO patients from 534 
      international centers between 2012-2021, excluding extracorporeal cardiopulmonary 
      resuscitation. Cochran-Armitage test and Poisson regression were used for trend 
      analysis of stroke incidence and mortality. Kaplan-Meier curves, hazard 
      functions, and multivariable logistic regression were used to study the impact of 
      stroke on 90-day mortality. RESULTS: Of 33,041 patients (median age = 58 years, 
      female = 32%), 4% developed ischemic stroke, and 2% developed hemorrhagic stroke. 
      Ischemic stroke incidence increased (x1.21/year, p < 0.0001), while hemorrhagic 
      stroke incidence remained stable, and overall 90-day mortality declined 
      (1.78%/year, p < 0.0001). Ischemic/hemorrhagic strokes were associated with 
      increased overall 90-day mortality (OR = 3.29, 3.99 respectively, both p < 
      0.0001) after controlling for pre-selected covariates, including age, 
      pre/post-cannulation lab values, ECMO duration, center volume, and on-ECMO 
      complications. Total center volume was associated positively with 
      ischemic/hemorrhagic stroke incidences (OR = 1.039, 1.053 
      per-additional-100-cases respectively, both p = 0.022), but inversely with 90-day 
      mortality (OR = 0.909 per-additional-100-cases, p < 0.0001). Hazard of death was 
      highest in the first several days of VA-ECMO. CONCLUSION: In VA-ECMO patients, 
      while the reported ischemic stroke incidence steadily increased over time, 90-day 
      mortality decreased. ELSO centers with higher case volumes reported greater 
      stroke incidence, but lower mortality. Both ischemic/hemorrhagic strokes were 
      associated with increased mortality.
FAU - Hwang, Jaeho
AU  - Hwang J
AD  - Johns Hopkins Hospital.
FAU - Kalra, Andrew
AU  - Kalra A
AD  - Johns Hopkins Hospital.
FAU - Shou, Benjamin L
AU  - Shou BL
AD  - Johns Hopkins Hospital.
FAU - Whitman, Glenn
AU  - Whitman G
AD  - Johns Hopkins Hospital.
FAU - Wilcox, Christopher
AU  - Wilcox C
AD  - Mercy Hospital of Buffalo.
FAU - Brodie, Daniel
AU  - Brodie D
AD  - Johns Hopkins University School of Medicine.
FAU - Zaaqoq, Akram M
AU  - Zaaqoq AM
AD  - University of Virginia.
FAU - Lorusso, Roberto
AU  - Lorusso R
AD  - Maastricht University Medical Centre.
FAU - Uchino, Ken
AU  - Uchino K
AD  - Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.
FAU - Cho, Sung-Min
AU  - Cho SM
AD  - Johns Hopkins Hospital.
LA  - eng
GR  - K23 HL157610/HL/NHLBI NIH HHS/United States
PT  - Preprint
DEP - 20230731
PL  - United States
TA  - Res Sq
JT  - Research square
JID - 101768035
UIN - Crit Care. 2023 Nov 9;27(1):433. PMID: 37946237
PMC - PMC10418528
OTO - NOTNLM
OT  - Mortality
OT  - Stroke
OT  - Trend
OT  - Venoarterial ECMO
COIS- Competing Interests JH None AK None BLS None GW None CW None DB Dr. Brodie 
      receives research support from and consults for LivaNova. He has been on the 
      medical advisory boards for Abiomed, Xenios, Medtronic, Inspira and Cellenkos. He 
      is the President-elect of the Extracorporeal Life Support Organization (ELSO) and 
      the Chair of the Executive Committee of the International ECMO Network (ECMONet), 
      and he writes for UpToDate AMZ None RL Dr. Lorusso is a consultant for Medtronic, 
      LivaNova, Getinge, Abiomed, and ChinaBridge Medical. He is a member of the 
      Medical Advisory Board for Xenios, Eurosets and Hemocue. He has also received 
      research grants from Medtronic and LivaNova. KU Dr. Uchino is a data safety 
      monitoring board member for clinical trials sponsored by Genentech, Inc., and 
      Evaheart, Inc. He is also a consultant for Abbott Laboraties, Inc. SMC Dr. Cho is 
      supported by a NHLBI grant (1K23HL157610).
EDAT- 2023/08/14 06:42
MHDA- 2023/08/14 06:43
PMCR- 2023/08/11
CRDT- 2023/08/14 05:02
PHST- 2023/08/14 06:42 [pubmed]
PHST- 2023/08/14 06:43 [medline]
PHST- 2023/08/14 05:02 [entrez]
PHST- 2023/08/11 00:00 [pmc-release]
AID - rs.3.rs-3200908 [pii]
AID - 10.21203/rs.3.rs-3200908/v1 [doi]
PST - epublish
SO  - Res Sq [Preprint]. 2023 Jul 31:rs.3.rs-3200908. doi: 10.21203/rs.3.rs-3200908/v1.