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Abstract Details

Understanding Characteristics of Acute Brain Injury in Adult ECMO: An Autopsy Study
Neuro Trauma, Critical Care, and Sports Neurology
S61 - Neurocritical Care: Cerebrovascular Disease (2:12 PM-2:24 PM)
007
Characterization of types, timing, and risk factors of acute brain injury in ECMO adult autopsy patients.
Current studies lack information on characteristics of ABI in ECMO patients. ABI may occur either before cannulation due to hemodynamic instability or underlying cardiopulmonary system failure, or during ECMO support secondary to risk factors such as thromboembolism, hypotension, hypoxia, loss of pulsatility and endothelial injury.
This retrospective cohort study reviewed clinical and pathological records from adult ECMO patients who had undergone brain autopsy from January 2009 through December 2018 at a single tertiary center.

Of 25 patients, 22 (88%) had venoarterial-ECMO (9 cardiac arrest; 13 cardiogenic shock) and 3 (12%) had venovenous-ECMO cannulation. The median ECMO support time was 96 (IQR 26-181) hours. The most common ABI was hypoxic ischemic brain injury (44%), followed by intracranial hemorrhage (24%), and ischemic infarct (16%). Subarachnoid hemorrhage (20%) was the most common type of intracranial hemorrhage, followed by intracerebral hemorrhage (8%), and subdural hemorrhage (4%). The most common involved location for HIBI was cerebral cortices (82%) and cerebellum (55%). The pattern of ischemic infarct was territorial in cerebral cortices. Risk factors for ABI included hypertension history (11 vs. 1, p=0.01), pre-ECMO antiplatelet use (7 vs. 0, p=0.03), and a higher day 1 lactate level (10.0 vs. 5.1, p=0.02). Patients with HIBI more frequently had hypertension (8 vs. 4, p=0.047), higher day 1 lactate levels (12.6 vs. 5.8, p=0.02), and lower pH (7.09 vs. 7.24, p=0.027). ECMO duration, cannulation methods, hemoglobin level, coma, renal and hepatic impairment were not associated with ABI.

In neuropathologic evaluation, 68% of ECMO autopsy patients developed ABI. HIBI was the most common type of injury suggesting ~50% of patients sustained ABI prior to or peri-cannulation period as a consequence of cardiogenic shock and cardiac arrest.
Authors/Disclosures
Giorgio Caturegli
PRESENTER
No disclosure on file
No disclosure on file
Sung-Min Cho No disclosure on file