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Lower Oxygen Tension and Intracranial Hemorrhage in Veno-venous Extracorporeal Membrane Oxygenation

  • INTRACRANIAL HEMORRHAGE WITH ECMO
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Abstract

Introduction and Methods

We examined the relationship between 24-h pre- and post-cannulation arterial oxygen tension (PaO2) and arterial carbon dioxide tension (PaCO2) and subsequent acute brain injury (ABI) in patients receiving veno-venous extracorporeal membrane oxygenation (VV-ECMO) with granular arterial blood gas (ABG) data and institutional standardized neuromonitoring.

Results

Eighty-nine patients underwent VV-ECMO (median age = 50, 63% male). Twenty (22%) patients experienced ABI; intracranial hemorrhage (ICH) was the most common diagnosis (n = 14, 16%). Lower post-cannulation PaO2 levels were significantly associated with ICH (66 vs. 81 mmHg, p = 0.007) and a post-cannulation PaO2 level < 70 mmHg was more frequent in these patients (71% vs. 33%, p = 0.007). PaCO2 parameters were not associated with ABI. By multivariable logistic regression, hypoxemia post-cannulation increased the odds of ICH (OR = 5.06, 95% CI:1.41–18.17; p = 0.01).

Conclusion

In summary, lower oxygen tension in the 24-h post-cannulation was associated with ICH development. The precise roles of peri-cannulation ABG changes deserve further investigation, as they may influence the management of VV-ECMO patients.

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Acknowledgements

HERALD (Hopkins Exploration, Research, and Advancement in Life support Devices) Investigators are as follows: Steven Keller, MD, PhD, Diane Alejo, Kate Calligy RN, Scott Anderson, Arjun Menta, BS, Philip Sun, MD, Jin Kook Kang, MD, Hannah Rando, MD, MPH, Ifeanyi Chinedozi, MD, Jaeho Hwang, MD, MPH, Zachary Darby, MD, Shrey Kapoor BS, Marc Sussman MD, Christopher Wilcox, DO, MS, Jiah Kim, MD, Patricia Brown RD-AP CNSC.

Funding

BLS received research funding from the Alpha Omega Alpha Honor Medical Society through the Carolyn L. Kuckein Student Research Fellowship during the conduct of this study. SMC is supported by the National Heart, Lung, and Blood Institute (1K23HL157610). Alpha Omega Alpha Honor Medical Society, Carolyn L. Kuckein Student Research Fellowship, National Heart, Lung, and Blood Institute, 1K23HL157610

Author information

Authors and Affiliations

  1. Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA

    Armaan F. Akbar, Benjamin L. Shou, Cheng-Yuan Feng, David X. Zhao & Glenn Whitman

  2. Division of Neurosciences Critical Care, Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, 600 N. Wolfe Street, Phipps, Baltimore, MD, 455, USA

    Cheng-Yuan Feng, David X. Zhao & Sung-Min Cho

  3. Division of Pulmonary and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD, USA

    Cheng-Yuan Feng, David X. Zhao & Bo Soo Kim

  4. Division of General Thoracic Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA

    Cheng-Yuan Feng, David X. Zhao & Errol L. Bush

Authors
  1. Armaan F. Akbar
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  2. Benjamin L. Shou
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  3. Cheng-Yuan Feng
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  4. David X. Zhao
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  5. Bo Soo Kim
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  6. Glenn Whitman
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  7. Errol L. Bush
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  8. Sung-Min Cho
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Consortia

the HERALD Investigators

  • Steven Keller
  • , Diane Alejo
  • , Kate Calligy
  • , Scott Anderson
  • , Arjun Menta
  • , Philip Sun
  • , Jin Kook Kang
  • , Hannah Rando
  • , Ifeanyi Chinedozi
  • , Jaeho Hwang
  • , Zachary Darby
  • , Shrey Kapoor
  • , Marc Sussman
  • , Christopher Wilcox
  • , Jiah Kim
  •  & Patricia Brown

Contributions

AFA, BLS, and SMC contributed to the study conception and design. Material preparation and data collection were performed by AFA, BLS, and DXZ. Data analysis was performed by AFA. The first draft of the manuscript was written by AFA and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Sung-Min Cho.

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Competing interests

The authors have no competing interests to declare that are relevant to the content of this article.

Ethical Approval

This was an observational study. This study was approved by the Johns Hopkins Institutional Review Board with a waiver of informed consent.

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The member of the HERALD Investigators are listed in acknowledgements section.

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Supplementary file1 (DOCX 36 KB)

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Akbar, A.F., Shou, B.L., Feng, CY. et al. Lower Oxygen Tension and Intracranial Hemorrhage in Veno-venous Extracorporeal Membrane Oxygenation. Lung 201, 315–320 (2023). https://doi.org/10.1007/s00408-023-00618-6

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  • DOI: https://doi.org/10.1007/s00408-023-00618-6

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