0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Contributions |

Neurological Injury in Adults Treated With Extracorporeal Membrane Oxygenation

Farrah J. Mateen, MD; Rajanandini Muralidharan, MD; Russell T. Shinohara, MSc; Joseph E. Parisi, MD; Gregory J. Schears, MD; Eelco F. M. Wijdicks, MD, PhD
Arch Neurol. 2011;68(12):1543-1549. doi:10.1001/archneurol.2011.209.
Text Size: A A A
Published online

Background Extracorporeal membrane oxygenation (ECMO) may be urgently used as a last resort form of life support when all other treatment options for potentially reversible cardiopulmonary injury have failed.

Objective To examine the range and frequency of neurological injury in ECMO-treated adults.

Design Retrospective clinicopathological cohort study.

Setting Mayo Clinic, Rochester, Minnesota.

Patients A prospectively collected registry of all patients 15 years or older treated with ECMO for 12 or more hours from January 2002 to April 2010.

Intervention Patients were analyzed for potential risk factors for neurological events and death using logistic regression and Cox proportional hazards models.

Main Outcome Measures Neurological diagnosis and/or death.

Results A total of 87 adults were treated (35 female [40%]; median age, 54 years [interquartile range, 31]; mean duration of ECMO, 91 hours [interquartile range, 100]; overall survival >7 days after ECMO, 52%). Neurological events occurred in 42 patients who received ECMO (50%; 95% confidence interval [CI], 39%-61%). Diagnoses included subarachnoid hemorrhage, ischemic watershed infarctions, hypoxic-ischemic encephalopathy, unexplained coma, and brain death. Death in patients who received ECMO who did not require antecedent cardiopulmonary resuscitation was associated with increased age (odds ratio, 1.24 per decade; 95% CI, 1.03-1.50; P = .02) and lower minimum arterial oxygen pressure (odds ratio, 0.79; 95% CI, 0.68-0.92; P = .03). Although stroke was rarely diagnosed clinically, 9 of 10 brains studied at autopsy demonstrated hypoxic-ischemic and hemorrhagic lesions of vascular origin.

Conclusion Severe neurological sequelae occur frequently in adult ECMO-treated patients with otherwise reversible cardiopulmonary injury (conservative estimate, 50%) and include a range of potentially fatal neurological diagnoses that may be due to the precipitating event and/or ECMO treatment.

Figures in this Article

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Figures

Place holder to copy figure label and caption
Graphic Jump Location

Figure 1. Flow diagram of adult patients treated with extracorporeal membrane oxygenation (ECMO) (n = 87).

Place holder to copy figure label and caption
Graphic Jump Location

Figure 2. Plot of Kaplan-Meier curve of time from extracorporeal membrane oxygenation (ECMO) initiation to death for all adult patients treated with ECMO by reason for ECMO treatment: after thoracic surgery (A; n = 73) and after CPR (B; n = 14).

Place holder to copy figure label and caption
Graphic Jump Location

Figure 3. Bar graph of patient survival times among nonsurvivors by reason for extracorporeal membrane oxygenation treatment (n = 62).

Place holder to copy figure label and caption
Graphic Jump Location

Figure 4. Diagnostic results of adult patients who received extracorporeal membrane oxygenation. The figure shows parafalcine subarachnoid hemorrhage and hydrocephalus on axial-view head computed tomography (A), diffuse subarachnoid hemorrhage on T1-weighted magnetic resonance imaging (B), and septic cerebral emboli on axial-view magnetic resonance imaging (C), which enhances with gadolinium-contrast; acute ischemic cell changes (“red dead neurons”) (D) and microscopic subacute ischemic thalamic infarction on histopathological sectioning (E); and diffuse petechial hemorrhages (F), subarachnoid hemorrhage (G), and massive intraventricular hemorrhage on gross pathological examination (H).

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles
Jobs
brightcove.createExperiences();