Cerebrovascular Complications of COVID-19 on Venovenous Extracorporeal Membrane Oxygenation

• Published in: Critical care medicine Vol. 51; no. 8; p. 1043
• Main Authors: Zaaqoq, Akram M, Griffee, Matthew J, Kelly, Thu-Lan, Fanning, Jonathon P, Heinsar, Silver, Suen, Jacky Y, Mariani, Silvia, Li Bassi, Gianluigi, Jacobs, Jeffrey P, White, Nicole, Fraser, John F, Lorusso, Roberto, Peek, Giles J, Cho, Sung-Min
• Format: Journal Article
• Language: English
• Published: United States 01.08.2023
• Subjects: Adult; Carbon Dioxide; COVID-19 - complications; COVID-19 - epidemiology; COVID-19 - therapy; Extracorporeal Membrane Oxygenation - adverse effects; Female; Humans; Male; Middle Aged; Obesity; Stroke - epidemiology; Stroke - etiology
• ISSN: 1530-0293
• DOI: 10.1097/CCM.0000000000005861

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. 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. Three hundred eighty institutions in 53 countries in the COVID-19 Critical Care Consortium (COVID Critical) registry. Adult COVID-19 patients who were supported by venovenous ECMO. None. 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. 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.