title: Neurological injury in adults treated with extracorporeal membrane oxygenation.
abstract: 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.
  
  
  METHODS
  Retrospective clinicopathological cohort study.
  
  
  METHODS
  Mayo Clinic, Rochester, Minnesota.
  
  
  METHODS
  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.
  
  
  METHODS
  Patients were analyzed for potential risk factors for neurological events and death using logistic regression and Cox proportional hazards models.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurology, Johns Hopkins University, 600 N Wolfe St, Baltimore, MD 21287, USA. fmateen@jhsph.edu
authors.forename: Farrah J
authors.initials: FJ
authors.lastname: Mateen
authors.forename: Rajanandini
authors.initials: R
authors.lastname: Muralidharan
authors.forename: Russell T
authors.initials: RT
authors.lastname: Shinohara
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Parisi
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Schears
authors.forename: Eelco F M
authors.initials: EF
authors.lastname: Wijdicks
mesh_terms: D000328:Adult; D000368:Aged; D001926:Brain Death; D001930:Brain Injuries / Q000209:etiology*; D016887:Cardiopulmonary Resuscitation; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D005260:Female; D006323:Heart Arrest / Q000150:complications* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome