Abstract Details

Title Comparison of Neurologic Complications of Veno-arterial Versus Veno-venous Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-analysis

Topic Neuro Trauma, Critical Care, and Sports Neurology

Presentation(s) S61 - Neurocritical Care: Cerebrovascular Disease (2:00 PM-2:12 PM)

Poster/Presentation
Number 006

Objective

We aimed to compare the prevalence of neurologic complications between patients undergoing veno-arterial (VA) and veno-venous (VV) extracorporeal membrane oxygenation (ECMO)

Background Despite a significant increase in the use of ECMO over the last decade, acute brain injury and neurologic complications are common. There has been little research comparing the rate of neurologic complications between VA-ECMO versus VV-ECMO

Design/Methods Following the Preferred Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, we searched PubMed and 6 other databases for observational studies and randomized clinical trials (RCTs) reporting neurologic complications and survival data of adult patients receiving VA- and VV-ECMO.

Results Of 9,056 studies screened, 53 studies met the inclusion criteria including 1 RCT and 52 observational studies. These encompassed 14,977 patients on ECMO, of whom 7,369 (49%) underwent VA-ECMO and 7,608 (51%) underwent VV-ECMO. The median age was 51 years (interquartile range: 44-56) with 9,491 (63%) males. Compared with VV-ECMO patients, VA-ECMO patients had higher prevalence of overall neurologic complications (17% [95% confidence interval (CI) 0.12-0.23] vs 10% [95% CI 0.07-0.15]; p=0.02). Specifically, VA-ECMO patients had higher rates of ischemic stroke (9% [95% CI 0.06 - 0.13] vs 1% [95% CI 0.00-0.03]; p<0.001), hypoxic ischemic encephalopathy (13% [95% CI 0.05-0.23] vs 1% [95% CI 0.00-0.04]; p<0.001), and brain death (10% [95% CI 0.04-0.18] vs 1% [95% CI 0.00-0.06]; p=0.003). No significant difference was seen in the prevalence of intracranial hemorrhage (p=0.4). Pooled survival analysis showed lower rates of survival in VA-ECMO patients compared to VV-ECMO patients (51% vs 64%, p=0.001)

Conclusions Patients on VA-ECMO support have a higher risk of neurologic injury compared to VV-ECMO. Ischemic stroke, hypoxic ischemic brain injury, and brain death were more common in VA-ECMO patients. The rate of intracranial hemorrhage was similar between VA- and VV-ECMO patients.

Authors/Disclosures
Aaron Shoskes, DO (University of Utah) PRESENTER	Dr. Shoskes has nothing to disclose.
Ibrahim Migdady, MD	Dr. Migdady has nothing to disclose.
	No disclosure on file
	No disclosure on file
Catherine Hassett, MD	Dr. Hassett has nothing to disclose.
	No disclosure on file
Sung M. Cho, DO (Johns Hopkins Hospital)	Dr. Cho has nothing to disclose.

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