Naslov
Cerebrovascular Complications of COVID-19 on Venovenous Extracorporeal Membrane Oxygenation

Autori
Zaaqoq, Akram ; Griffee, Matthew J. ; (...) ; Bradić, Nikola ; (...) ; Cho, Sung-Min ; COVID-19 Critical Care Consortium (COVID Critical)

Izvornik
Critical care medicine (0090-3493) 51 (2023); 37010526, 11

Vrsta, podvrsta i kategorija rada
Radovi u časopisima, članak, znanstveni

Ključne riječi
extracorporeal membrane oxygenation ; intracranial hemorrhage ; severe acute respiratory syndrome-related coronavirus ; stroke ; venovenous extracorporeal membrane oxygenation

Sažetak
OBJECTIVES: Evidence of cerebrovascular complications in COVID-19 requiring venovenous extracorporeal membrane oxygenation (ECMO) is limited. Our study aims to characterize the prevalence and risk factors of stroke secondary to COVID-19 in patients on venovenous ECMO. DESIGN: We analyzed prospectively collected observational data, using univariable and multivariable survival modeling to identify risk factors for stroke. Cox proportional hazards and Fine-Gray models were used, with death and discharge treated as competing risks. SETTING: Three hundred eighty institutions in 53 countries in the COVID-19 Critical Care Consortium (COVID Critical) registry. PATIENTS: Adult COVID-19 patients who were supported by venovenous ECMO. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Five hundred ninety-five patients (median age [interquartile range], 51 yr [42–59 yr] ; male: 70.8%) had venovenous ECMO support. Forty-three patients (7.2%) suffered strokes, 83.7% of which ere hemorrhagic. In multivariable survival analysis, obesity (adjusted hazard ratio [aHR], 2.19 ; 95% CI, 1.05–4.59) and use of vasopressors before ECMO (aHR, 2.37 ; 95% CI, 1.08–5.22) were associated with an increased risk of stroke. Forty-eight-hour post-ECMO Paco2–pre-ECMO Paco2/pre-ECMO Paco2 (relative ΔPaco2) of negative 26% and 48-hour post-ECMO Pao2–pre-ECMO Pao2/pre-ECMO Pao2 (relative ΔPao2) of positive 24% at 48 hours of ECMO initiation were observed in stroke patients in comparison to relative ΔPaco2 of negative 17% and relative ΔPao2 of positive 7% in the nonstroke group. Patients with acute stroke had a 79% in- hospital mortality compared with 45% mortality for stroke-free patients. CONCLUSIONS: Our study highlights the association of obesity and pre-ECMO vasopressor use with the development of stroke in COVID-19 patients on venovenous ECMO. Also, the importance of relative decrease in Paco2 and moderate hyperoxia within 48 hours after ECMO initiation were additional risk factors.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

POVEZANOST RADA