Incidence of early intra-cranial bleeding and ischaemia in adult veno-arterial extracorporeal membrane oxygenation and extracorporeal cardiopulmonary resuscitation patients: a retrospective analysis of risk factors
Incidence of early intra-cranial bleeding and ischaemia in adult veno-arterial extracorporeal membrane oxygenation and extracorporeal cardiopulmonary resuscitation patients: a retrospective analysis of risk factors
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DOI：
10.1177/0267659120907438
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发表时间：
2020-05-01
期刊：
影响因子：
1.2
通讯作者：
Mueller, Thomas
中科院分区：
文献类型：
--
作者：
Malfertheiner, Maximilian Valentin;Koch, Andrea;Mueller, Thomas
背景：已知静脉-动脉体外膜肺氧合中的脑部并发症对死亡率和发病率有很大影响。本研究的目的是探讨早期发病率，危险因素和颅内缺血和出血的成年人接受静脉动脉体外膜肺氧合treatment.Methods：本研究是一个单中心的回顾性分析成人患者接受静脉动脉体外膜肺氧合不同的适应症。入选标准包括体外膜肺氧合期间早期常规脑计算机断层扫描成像的患者，插管前无脑病理学临床证据。脑并发症进行了分组的病因和领土的大脑的supporting arteries.Results：一百八十七名成人患者，共190静脉动脉体外膜肺氧合治疗。共有16.3%（n=31）的患者有脑缺血（11.1%）或出血（5.8%）的证据; 1例患者同时患有脑缺血和出血。在体外膜氧合插管后第一天的中位数早期进行了脑计算机断层扫描;颅内缺血和出血的住院死亡率分别为71.4%和45.5%。与缺血性病变风险增加相关的是升主动脉插管、年龄较大、自身免疫性疾病的存在和静脉-动脉体外膜肺氧合前的心脏手术。发现与出血性病变相关的是2 h时较低的PaCO 2、2 h时通过体外膜肺氧合装置的较低血流量、较高的国际标准化比率和持续较高的活化部分凝血活酶时间值以及较高的平均动脉压，直至出血性病变明显。脑并发症在接受静脉-动脉体外膜肺氧合的患者中很常见，可能是临床上无症状的事件。常规神经影像学仔细监测似乎是目前最合适的诊断方法。颅内缺血比出血更常见，与升主动脉插管有关。
Background: Cerebral complications in veno-arterial extracorporeal membrane oxygenation are known to have a strong impact on mortality and morbidity. Aim of this study is to investigate the early incidence, risk factors and in-hospital mortality of intra-cranial ischaemia and haemorrhage in adults undergoing veno-arterial extracorporeal membrane oxygenation treatment.Methods: This study is a single-centre retrospective analysis on adult patients undergoing veno-arterial extracorporeal membrane oxygenation for different indications. The inclusion criterion included patients with early routine cerebral computed tomography imaging during extracorporeal membrane oxygenation, with no clinical evidence of cerebral pathology prior to cannulation. Cerebral complications were grouped by aetiology and the territories of the brain's supplying arteries.Results: One hundred eighty-seven adult patients with a total of 190 veno-arterial extracorporeal membrane oxygenation treatments were included. A total of 16.3% (n=31) had evidence of either cerebral ischaemia (11.1%) or haemorrhage (5.8%); one patient suffered from both. Cerebral computed tomography scans were performed early in median on the first day after extracorporeal membrane oxygenation cannulation; in-hospital mortality of intra-cranial ischaemia and haemorrhage was 71.4% and 45.5%, respectively. Associated with an increased risk for ischaemic lesions were cannulation of the ascending aorta, higher age, presence of an autoimmune disease and cardiac surgery prior to veno-arterial extracorporeal membrane oxygenation. An association with haemorrhagic lesions was found for a lower blood PaCO2 at 2hours, lower blood flow through the extracorporeal membrane oxygenation device at 2hours, higher international normalized ratio and constantly higher activated partial thromboplastin time values as well as higher mean arterial pressures until haemorrhagic lesions were evident.Conclusion: Cerebral complications are frequent in patients on veno-arterial extracorporeal membrane oxygenation and may be clinically silent events. Careful monitoring with routine neuroimaging seems to be the most appropriate diagnostic approach at present. Intra-cranial ischaemia occurs more frequent than haemorrhage and is associated with cannulation of the aorta ascendens.