ABSTRACT
Background: Hemorrhagic stroke (HS) is a devastating complication during extracorporeal membrane oxygenation (ECMO), but markers for risk stratification are unknown. Lactate dehydrogenase (LDH) is a readily available biomarker of global tissue injury and permeability. We sought to determine whether an elevated LDH at baseline is related to eventual HS during ECMO for COVID-19. Method(s): A multicenter, retrospective study was conducted. Adult patients with COVID-19 requiring ECMO between March 2020 and February 2022 were included. LDH values prior to ECMO were captured. Patients were categorized into high (>750 U/L) or low (<=750 U/L) LDH groups. Result(s): There were 520 patients (47+/-11 years old) that underwent ECMO placement in 17 centers and 384 had an available LDH. In this cohort, 122 (32%) had a high LDH. Forty (10%) patients required venoarterial ECMO, while the remaining 344 (90%) received venovenous support only. Twenty-one out of 122 (17%) patients with a high LDH had a HS in comparison to 21 out of 262 (8%) with a low LDH. At 100 days, the probability of a HS was 40% in the high LDH group and 23% in those with a low LDH, p=0.002. After adjustment for age, sex and antecedent cardiopulmonary resuscitation, high LDH was associated with subsequent HS (aHR: 2.73, 95% CI 1.46-5.12). Findings were similar when restricting to patients supported by venovenous ECMO only. Conclusion(s): Elevated LDH prior to ECMO is associated with a HS during device support. LDH can risk stratify cases for impending cerebral bleeding during ECMO.