Cerebrovascular Complications of COVID-19 on Venovenous Extracorporeal Membrane Oxygenation.
Crit Care Med
; 51(8): 1043-1053, 2023 Aug 01.
Article
in English
| MEDLINE | ID: covidwho-2288178
ABSTRACT
OBJECTIVES:
Evidence of cerebrovascular complications in COVID-19 requiring venovenous extracorporeal membrane oxygenation (ECMO) is limited. Our study aims to characterize the prevalence and risk factors of stroke secondary to COVID-19 in patients on venovenous ECMO.DESIGN:
We analyzed prospectively collected observational data, using univariable and multivariable survival modeling to identify risk factors for stroke. Cox proportional hazards and Fine-Gray models were used, with death and discharge treated as competing risks.SETTING:
Three hundred eighty institutions in 53 countries in the COVID-19 Critical Care Consortium (COVID Critical) registry. PATIENTS Adult COVID-19 patients who were supported by venovenous ECMO.INTERVENTIONS:
None. MEASUREMENTS AND MAINRESULTS:
Five hundred ninety-five patients (median age [interquartile range], 51 yr [42-59 yr]; male 70.8%) had venovenous ECMO support. Forty-three patients (7.2%) suffered strokes, 83.7% of which were hemorrhagic. In multivariable survival analysis, obesity (adjusted hazard ratio [aHR], 2.19; 95% CI, 1.05-4.59) and use of vasopressors before ECMO (aHR, 2.37; 95% CI, 1.08-5.22) were associated with an increased risk of stroke. Forty-eight-hour post-ECMO Pa co2 -pre-ECMO Pa co2 /pre-ECMO Pa co2 (relative ΔPa co2 ) of negative 26% and 48-hour post-ECMO Pa o2 -pre-ECMO Pa o2 /pre-ECMO Pa o2 (relative ΔPa o2 ) of positive 24% at 48 hours of ECMO initiation were observed in stroke patients in comparison to relative ΔPa co2 of negative 17% and relative ΔPa o2 of positive 7% in the nonstroke group. Patients with acute stroke had a 79% in-hospital mortality compared with 45% mortality for stroke-free patients.CONCLUSIONS:
Our study highlights the association of obesity and pre-ECMO vasopressor use with the development of stroke in COVID-19 patients on venovenous ECMO. Also, the importance of relative decrease in Pa co2 and moderate hyperoxia within 48 hours after ECMO initiation were additional risk factors.
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Extracorporeal Membrane Oxygenation
/
Stroke
/
COVID-19
Type of study:
Experimental Studies
/
Observational study
/
Prognostic study
Limits:
Adult
/
Humans
/
Male
Language:
English
Journal:
Crit Care Med
Year:
2023
Document Type:
Article
Similar
MEDLINE
...
LILACS
LIS