title: Incidence and predictors of ischemic cerebrovascular stroke among patients on extracorporeal membrane oxygenation support.
abstract: BACKGROUND
  There are scant data on the predictors of ischemic cerebrovascular stroke occurring during extracorporeal membrane oxygenation (ECMO). We investigated the incidence and predictors of ischemic stroke in subjects receiving ECMO support.
  
  
  METHODS
  A retrospective chart review was conducted on consecutive adult subjects (>18 years of age) who received ECMO at Tampa General Hospital from 2007 to 2014 with the main outcome variable being the onset of radiologically confirmed ischemic stroke during ECMO support. We examined various risk factors for ischemic stroke including patients' demographics, clinical and laboratory variables, ECMO characteristics, type and amount of transfused blood products, and the indications necessitating ECMO support. To identify independent risk factors of ischemic stroke during ECMO and adjust for confounding variables, a multivariate logistic regression analysis was used.
  
  
  RESULTS
  A total of 171 subjects received ECMO (mean age was 51 years, and 74.9% were male) for cardiac or pulmonary indications. Ten subjects (5.8%) developed ischemic stroke during ECMO. Cases with ischemic stroke had a higher mean pre-ECMO lactic acid level (10.6 ± 6.5 vs 6.3 ± 5.2 mmol/L, P= .039) and a higher frequency of pre-ECMO lactic acid level > 10 mmol/L (71.4% vs 24.8%, P = .019). Multivariate analysis identified that a pre-ECMO lactic acid greater than 10 mmol/L (odds ratio, 7.586; 95% CI, 1.396-41.223; P = .019) is an independent predictor of ischemic stroke occurring during ECMO support.
  
  
  CONCLUSIONS
  Ischemic stroke is not uncommon in subjects receiving ECMO support with independent risk factor being a pre-ECMO lactic acid greater than 10 mmol/L.
authors.affiliation: Internal Medicine Department, Mercy Medical Center, Clinton, IA, USA.
authors.forename: Hesham R
authors.initials: HR
authors.lastname: Omar
authors.affiliation: Division of Pulmonary, Critical Care, Sleep and Allergy, University of Miami, Miller School of Medicine, FL, USA; Section of Pulmonary, Department of Medicine, Miami VA Medical Center, Miami, FL, USA. Electronic address: msm249@med.miami.edu.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Mirsaeidi
authors.affiliation: Department of Research, Florida Gulf-to-Bay Anesthesiology Associates, Tampa FL, USA.
authors.forename: Jacob
authors.initials: J
authors.lastname: Shumac
authors.affiliation: Department of Research, Florida Gulf-to-Bay Anesthesiology Associates, Tampa FL, USA.
authors.forename: Garrett
authors.initials: G
authors.lastname: Enten
authors.affiliation: Tampa General Hospital, Tampa, FL, USA; FGTBA and TEAMHealth, Tampa, FL, USA.
authors.forename: Devanand
authors.initials: D
authors.lastname: Mangar
authors.affiliation: FGTBA and TEAMHealth, Tampa, FL, USA; University of South Florida, Tampa, FL, USA.
authors.forename: Enrico M
authors.initials: EM
authors.lastname: Camporesi
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D016638:Critical Illness / Q000401:mortality* / Q000628:therapy; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000401:mortality; D005260:Female; D005431:Florida / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000097:blood / Q000453:epidemiology* / Q000209:etiology
chemical_list: D015415:Biomarkers; D019344:Lactic Acid
keywords: ECMO; Extracorporeal membrane oxygenation; Ischemic; Stroke