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Semin Thromb Hemost 2018; 44(03): 276-286
DOI: 10.1055/s-0038-1636840
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Intracranial Hemorrhage and Early Mortality in Patients Receiving Extracorporeal Membrane Oxygenation for Severe Respiratory Failure

Deepa R.J. Arachchillage
1   Department of Haematology, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
2   Department of Haematology, Imperial College Healthcare NHS Trust and Imperial College London, London, United Kingdom
,
Maurizio Passariello
3   Adult Intensive Care Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
,
Michael Laffan
2   Department of Haematology, Imperial College Healthcare NHS Trust and Imperial College London, London, United Kingdom
,
TC Aw
4   Department of Anaesthesia, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
,
Leah Owen
3   Adult Intensive Care Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
,
Winston Banya
5   Department of Medical Statistics, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
,
Richard Trimlett
3   Adult Intensive Care Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
,
Cliff Morgan
3   Adult Intensive Care Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
,
Brijesh V. Patel
3   Adult Intensive Care Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
6   Section of Anaesthesia, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
,
John Pepper
7   Department of Cardiothoracic Surgery, National Heart and Lung Institute, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
,
Stephane Ledot
3   Adult Intensive Care Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
› Author Affiliations
Further Information

Publication History

Publication Date:
22 March 2018 (online)

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Abstract

Intracranial hemorrhage (ICH) is a serious complication in patients receiving veno-venous extracorporeal membrane oxygenation (VV-ECMO) and is associated with high mortality. It is unknown whether ICH may be a consequence of the ECMO or of an underlying disease. The authors first aimed to assess the incidence of ICH at initiation and during the course of VV-ECMO and its associated mortality. The second aim was to identify clinical and laboratory measures that could predict the development of ICH in severe respiratory failure. Data were collected from a total number of 165 patients receiving VV-ECMO from January, 2012 to December, 2016 in a single tertiary center and treated according to a single protocol. Only patients who had a brain computed tomography within 24 hours of initiation of ECMO (n = 149) were included for analysis. The prevalence and incidence of ICH at initiation and during the course of VV-ECMO (at median 9 days) were 10.7% (16/149) and 5.2% (7/133), respectively. Thrombocytopenia and reduced creatinine clearance (CrCL) were independently associated with increased risk of ICH on admission; odds ratio (95% confidence interval): 22.6 (2.6–99.5), and 10.8 (5.6–16.2). Only 30-day (not 180-day) mortality was significantly higher in patients with ICH on admission versus those without (37.5% [6/16] vs 16.4% [22/133]; p = 0.03 and 43.7% [7/16] vs 26.3% [35/133]; p = 0.15, respectively). Reduced CrCL and thrombocytopenia were associated with ICH at initiation of VV-ECMO. The higher incidence of ICH at initiation suggests it is more closely related to the severity of the underlying lung injury than to the VV-ECMO itself. ICH at VV-ECMO initiation was associated with early mortality.

Keywords

extracorporeal membrane oxygenation - respiratory failure - intracranial hemorrhage - cerebral ischemic infarction - venous thrombosis - anticoagulation

Author contributions

D.R.J. Arachchillage was responsible for design of the study, acquiring data, some of the statistical analysis, interpretation of the data, and writing the first draft of the manuscript. M. Laffan, J. Pepper, and B. Patel critically evaluated the manuscript. M. Passariello, T.C. Aw, L. Owen, and S. Ledot collected the data. W. Banya performed statistically analysis. All authors commented and approved the final manuscript.