PMID- 38333077 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20240210 IS - 2639-8028 (Electronic) IS - 2639-8028 (Linking) VI - 6 IP - 2 DP - 2024 Feb TI - Association of Sepsis With Neurologic Outcomes of Adult Patients Treated With Venoarterial Extracorporeal Membrane Oxygnenation. PG - e1042 LID - 10.1097/CCE.0000000000001042 [doi] LID - e1042 AB - OBJECTIVES: Neurologic outcomes of patients under venoarterial extracorporeal membrane oxygenation (VA-ECMO) may be worsened by secondary insults of systemic origin. We aimed to assess whether sepsis, commonly observed during ECMO support, is associated with brain injury and outcomes. DESIGN: Single-center cohort study of the "exposed-non-exposed" type on consecutive adult patients treated by VA-ECMO. SETTING: Medical ICU of a university hospital, France, 2013-2020. PATIENTS: Patients with sepsis at the time of VA-ECMO cannulation ("sepsis" group) were compared with patients without sepsis ("no sepsis" group). The primary outcome measure was poor functional outcome at 90 days, defined by a score greater than or equal to 4 on the modified Rankin scale (mRS), indicating severe disability or death. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 196 patients were included ("sepsis," n = 128; "no sepsis," n = 68), of whom 87 (44.4%) had presented cardiac arrest before VA-ECMO cannulation. A poor functional outcome (mRS >/= 4) was observed in 99 of 128 patients (77.3%) of the "sepsis" group and 46 of 68 patients (67.6%) of the "no sepsis" group (adjusted logistic regression odds ratio (OR) 1.21, 95% CI, 0.58-2.47; inverse probability of treatment weighting (IPTW) OR 1.24; 95% CI, 0.79-1.95). Subsequent analyses performed according to pre-ECMO cardiac arrest status suggested that sepsis was independently associated with poorer functional outcomes in the subgroup of patients who had experienced pre-ECMO cardiac arrest (adjusted logistic regression OR 3.44; 95% CI, 1.06-11.40; IPTW OR 3.52; 95% CI, 1.68-7.73), whereas no such association was observed in patients without pre-ECMO cardiac arrest (adjusted logistic regression OR 0.69; 95% CI, 0.27-1.69; IPTW OR 0.76; 95% CI, 0.42-1.35). Compared with the "no sepsis" group, "sepsis" patients presented a significant increase in S100 calcium-binding protein beta concentrations at day 1 (0.94 mug/L vs. 0.52 mug/L, p = 0.03), and more frequent EEG alterations (i.e., severe slowing, discontinuous background, and a lower prevalence of sleep patterns), suggesting brain injury. CONCLUSION: We observed a detrimental role of sepsis on neurologic outcomes in the subgroup of patients who had experienced pre-ECMO cardiac arrest, but not in other patients. CI - Copyright (c) 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine. FAU - Tridon, Chloe AU - Tridon C AD - Medecine intensive-reanimation, AP-HP, Hopital Bichat-Claude Bernard, Paris, France. FAU - Bachelet, Delphine AU - Bachelet D AD - Physiologie-Explorations Fonctionnelles, FHU APOLLO, DMU DREAM, Assistance Publique Hopitaux de Paris, Hopital Bichat-Claude Bernard, Paris, France. FAU - El Baied, Majda AU - El Baied M AD - Physiologie-Explorations Fonctionnelles, FHU APOLLO, DMU DREAM, Assistance Publique Hopitaux de Paris, Hopital Bichat-Claude Bernard, Paris, France. FAU - Eloy, Philippine AU - Eloy P AD - Physiologie-Explorations Fonctionnelles, FHU APOLLO, DMU DREAM, Assistance Publique Hopitaux de Paris, Hopital Bichat-Claude Bernard, Paris, France. FAU - Ortuno, Sofia AU - Ortuno S AD - Medecine intensive-reanimation, AP-HP, Hopital Bichat-Claude Bernard, Paris, France. FAU - Para, Marylou AU - Para M AD - Service de Chirurgie Cardiaque, AP-HP, Hopital Bichat-Claude Bernard, Paris, France. Universite de Paris Cite, INSERM U1148, Paris, France. FAU - Wicky, Paul-Henri AU - Wicky PH AD - Medecine intensive-reanimation, AP-HP, Hopital Bichat-Claude Bernard, Paris, France. FAU - Vellieux, Geoffroy AU - Vellieux G AD - Neurophysiologie clinique, service de Physiologie-Explorations Fonctionnelles, AP-HP, Hopital Bichat-Claude Bernard, Paris, France. FAU - de Montmollin, Etienne AU - de Montmollin E AD - Medecine intensive-reanimation, AP-HP, Hopital Bichat-Claude Bernard, Paris, France. AD - Universite de Paris, IAME, INSERM, UMR1137, Paris, France. FAU - Bouadma, Lila AU - Bouadma L AD - Medecine intensive-reanimation, AP-HP, Hopital Bichat-Claude Bernard, Paris, France. AD - Universite de Paris, IAME, INSERM, UMR1137, Paris, France. FAU - Manceau, Hana AU - Manceau H AD - Universite de Paris, IAME, INSERM, UMR1137, Paris, France. AD - Biochimie, Assistance Publique Hopitaux de Paris, Hopital Bichat-Claude Bernard, Paris, France. FAU - Timsit, Jean-Francois AU - Timsit JF AD - Medecine intensive-reanimation, AP-HP, Hopital Bichat-Claude Bernard, Paris, France. AD - Universite de Paris, IAME, INSERM, UMR1137, Paris, France. FAU - Peoc'h, Katell AU - Peoc'h K AD - Universite de Paris, IAME, INSERM, UMR1137, Paris, France. AD - Biochimie, Assistance Publique Hopitaux de Paris, Hopital Bichat-Claude Bernard, Paris, France. FAU - Sonneville, Romain AU - Sonneville R AD - Medecine intensive-reanimation, AP-HP, Hopital Bichat-Claude Bernard, Paris, France. AD - Universite de Paris, IAME, INSERM, UMR1137, Paris, France. LA - eng PT - Journal Article DEP - 20240207 PL - United States TA - Crit Care Explor JT - Critical care explorations JID - 101746347 PMC - PMC10852385 OTO - NOTNLM OT - S100 calcium-binding protein beta OT - brain injury OT - extracorporeal membrane oxygenation OT - neuron-specific enolase OT - sepsis COIS- The authors have disclosed that they do not have any potential conflicts of interest. EDAT- 2024/02/09 06:43 MHDA- 2024/02/09 06:44 PMCR- 2024/02/07 CRDT- 2024/02/09 03:52 PHST- 2024/02/09 06:44 [medline] PHST- 2024/02/09 06:43 [pubmed] PHST- 2024/02/09 03:52 [entrez] PHST- 2024/02/07 00:00 [pmc-release] AID - 10.1097/CCE.0000000000001042 [doi] PST - epublish SO - Crit Care Explor. 2024 Feb 7;6(2):e1042. doi: 10.1097/CCE.0000000000001042. eCollection 2024 Feb.