tetano
Editor, Senior Moderator
Heart Lung Circ
. 2021 Oct 28;S1443-9506(21)01292-0.
doi: 10.1016/j.hlc.2021.10.007. Online ahead of print.
Neurological Complications in COVID-19 Patients With ECMO Support: A Systematic Review and Meta-Analysis
Nivedha V Kannapadi[SUP] 1 [/SUP], Meghana Jami[SUP] 1 [/SUP], Lavienraj Premraj[SUP] 2 [/SUP], Eric W Etchill[SUP] 3 [/SUP], Katherine Giuliano[SUP] 3 [/SUP], Errol L Bush[SUP] 3 [/SUP], Bo Soo Kim[SUP] 4 [/SUP], Stella Seal[SUP] 5 [/SUP], Glenn Whitman[SUP] 3 [/SUP], Sung-Min Cho[SUP] 6 [/SUP]
Affiliations
Abstract
Background: Patients with Coronavirus disease 2019 (COVID-19)-related acute respiratory disease (ARDS) increasingly receive extracorporeal membrane oxygenation (ECMO) support. While ECMO has been shown to increase risk of stroke, few studies have examined this association in COVID-19 patients.
Objective: We conducted a systematic review to characterise neurological events during ECMO support in COVID-19 patients.
Design: Systematic review of cohort and large case series of COVID-19 patients who received ECMO support.
Data sources: Studies retrieved from PubMed, EMBASE, Cochrane, Cochrane COVID-19 Study Register, Web of Science, Scopus, Clinicaltrials.gov, and mdRxiv from inception to November 11, 2020.
Eligibility criteria: Inclusion criteria were a) Adult population (>18 year old); b) Positive PCR test for SARS-CoV-2 with active COVID-19 disease; c) ECMO therapy due to COVID-19 ARDS; and d) Neurological events and outcome described while on ECMO support. We excluded articles when no details of neurologic events were available.
Results: 1,322 patients from 12 case series and retrospective cohort studies were included in our study. The median age was 49.2, and 75% (n=985) of the patients were male. Diabetes mellitus and dyslipidaemia were the most common comorbidities (24% and 20%, respectively). Most (95%, n=1,241) patients were on venovenous ECMO with a median P:F ratio at the time of ECMO cannulation of 69.1. The prevalence of intracranial haemorrhage (ICH), ischaemic stroke, and hypoxic ischaemic brain injury (HIBI) was 5.9% (n=78), 1.1% (n=15), and 0.3% (n=4), respectively. The overall mortality of the 1,296 ECMO patients in the 10 studies that reported death was 36% (n=477), and the mortality of the subset of patients who had a neurological event was 92%.
Conclusions: Neurological injury is a concern for COVID-19 patients who receive ECMO. Further research is required to explore how neuromonitoring protocols can inform tailored anticoagulation management and improve survival in COVID-19 patients with ECMO support.
Keywords: COVID-19; ECMO; Intracranial haemorrhage; Stroke.
. 2021 Oct 28;S1443-9506(21)01292-0.
doi: 10.1016/j.hlc.2021.10.007. Online ahead of print.
Neurological Complications in COVID-19 Patients With ECMO Support: A Systematic Review and Meta-Analysis
Nivedha V Kannapadi[SUP] 1 [/SUP], Meghana Jami[SUP] 1 [/SUP], Lavienraj Premraj[SUP] 2 [/SUP], Eric W Etchill[SUP] 3 [/SUP], Katherine Giuliano[SUP] 3 [/SUP], Errol L Bush[SUP] 3 [/SUP], Bo Soo Kim[SUP] 4 [/SUP], Stella Seal[SUP] 5 [/SUP], Glenn Whitman[SUP] 3 [/SUP], Sung-Min Cho[SUP] 6 [/SUP]
Affiliations
- PMID: 34756659
- PMCID: PMC8553269
- DOI: 10.1016/j.hlc.2021.10.007
Abstract
Background: Patients with Coronavirus disease 2019 (COVID-19)-related acute respiratory disease (ARDS) increasingly receive extracorporeal membrane oxygenation (ECMO) support. While ECMO has been shown to increase risk of stroke, few studies have examined this association in COVID-19 patients.
Objective: We conducted a systematic review to characterise neurological events during ECMO support in COVID-19 patients.
Design: Systematic review of cohort and large case series of COVID-19 patients who received ECMO support.
Data sources: Studies retrieved from PubMed, EMBASE, Cochrane, Cochrane COVID-19 Study Register, Web of Science, Scopus, Clinicaltrials.gov, and mdRxiv from inception to November 11, 2020.
Eligibility criteria: Inclusion criteria were a) Adult population (>18 year old); b) Positive PCR test for SARS-CoV-2 with active COVID-19 disease; c) ECMO therapy due to COVID-19 ARDS; and d) Neurological events and outcome described while on ECMO support. We excluded articles when no details of neurologic events were available.
Results: 1,322 patients from 12 case series and retrospective cohort studies were included in our study. The median age was 49.2, and 75% (n=985) of the patients were male. Diabetes mellitus and dyslipidaemia were the most common comorbidities (24% and 20%, respectively). Most (95%, n=1,241) patients were on venovenous ECMO with a median P:F ratio at the time of ECMO cannulation of 69.1. The prevalence of intracranial haemorrhage (ICH), ischaemic stroke, and hypoxic ischaemic brain injury (HIBI) was 5.9% (n=78), 1.1% (n=15), and 0.3% (n=4), respectively. The overall mortality of the 1,296 ECMO patients in the 10 studies that reported death was 36% (n=477), and the mortality of the subset of patients who had a neurological event was 92%.
Conclusions: Neurological injury is a concern for COVID-19 patients who receive ECMO. Further research is required to explore how neuromonitoring protocols can inform tailored anticoagulation management and improve survival in COVID-19 patients with ECMO support.
Keywords: COVID-19; ECMO; Intracranial haemorrhage; Stroke.