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Neurological Injury in Adults Treated With Extracorporeal Membrane Oxygenation.
MedLine Citation:
PMID:  21825216     Owner:  NLM     Status:  Publisher    
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) may be urgently used as a last resort form of life support when all other treatment options for potentially reversible cardiopulmonary injury have failed. OBJECTIVE: To examine the range and frequency of neurological injury in ECMO-treated adults. DESIGN: Retrospective clinicopathological cohort study. SETTING: Mayo Clinic, Rochester, Minnesota. Patients  A prospectively collected registry of all patients 15 years or older treated with ECMO for 12 or more hours from January 2002 to April 2010. Intervention  Patients were analyzed for potential risk factors for neurological events and death using logistic regression and Cox proportional hazards models. MAIN OUTCOME MEASURES: Neurological diagnosis and/or death. RESULTS: A total of 87 adults were treated (35 female [40%]; median age, 54 years [interquartile range, 31]; mean duration of ECMO, 91 hours [interquartile range, 100]; overall survival >7 days after ECMO, 52%). Neurological events occurred in 42 patients who received ECMO (50%; 95% confidence interval [CI], 39%-61%). Diagnoses included subarachnoid hemorrhage, ischemic watershed infarctions, hypoxic-ischemic encephalopathy, unexplained coma, and brain death. Death in patients who received ECMO who did not require antecedent cardiopulmonary resuscitation was associated with increased age (odds ratio, 1.24 per decade; 95% CI, 1.03-1.50; P = .02) and lower minimum arterial oxygen pressure (odds ratio, 0.79; 95% CI, 0.68-0.92; P = .03). Although stroke was rarely diagnosed clinically, 9 of 10 brains studied at autopsy demonstrated hypoxic-ischemic and hemorrhagic lesions of vascular origin. CONCLUSION: Severe neurological sequelae occur frequently in adult ECMO-treated patients with otherwise reversible cardiopulmonary injury (conservative estimate, 50%) and include a range of potentially fatal neurological diagnoses that may be due to the precipitating event and/or ECMO treatment.
Farrah J Mateen; Rajanandini Muralidharan; Russell T Shinohara; Joseph E Parisi; Gregory J Schears; Eelco F M Wijdicks
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-8-8
Journal Detail:
Title:  Archives of neurology     Volume:  -     ISSN:  1538-3687     ISO Abbreviation:  -     Publication Date:  2011 Aug 
Date Detail:
Created Date:  2011-8-9     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372436     Medline TA:  Arch Neurol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
School of Medicine (Dr Mateen), and Biostatistics, Bloomberg School of Public Health (Mr Shinohara), Johns Hopkins University, Baltimore, Maryland; and Departments of Neurology (Drs Mateen, Muralidharan, and Wijdicks), Pathology and Laboratory Medicine (Dr Parisi), and Anesthesiology (Dr Schears), Mayo Clinic, Rochester, Minnesota.
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