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Stroke patterns and cannulation strategy during veno-arterial extracorporeal membrane support

  • Original Article
  • Artificial Lung / ECMO
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Abstract

Stroke has potentially devastating consequences for patients receiving veno-arterial extracorporeal membrane support (VA-ECMO). Arterial cannulation sites for VA-ECMO include the ascending aorta, axillary artery, and femoral artery. However, the influence of cannulation site on stroke risk has not been well described. The purpose of this study was to investigate the association between occurrence and patterns of stroke with ECMO arterial cannulation sites. We retrospectively reviewed 414 consecutive patients who received VA-ECMO support for cardiogenic shock between March 2007 and May 2018. Patients were categorized by cannulation strategy. The rates, subtype and location of strokes as assessed by neuroimaging during and after VA-ECMO support were analyzed. Median age was 61 years (IQR 50–69); 67% were men. 77 patients were cannulated via the ascending aorta (17%), 31 via the axillary artery (7%), and 306 (69%) via the femoral artery. In total, 26 patients (6.3%) developed 30 stroke lesions at a median of 6.0 (IQR 3.1–8.7) days after ECMO cannulation. Ischemic stroke was the most common subtype (64%), followed by hemorrhagic transformation (20%) and hemorrhagic stroke (16%). Location by CT was right hemispheric in 38%, left hemispheric in 24%, bilateral in 21%, and vertebrobasilar in 17%. The incidence of stroke was similar across cannulation strategies: aorta (n = 5, 6.5%), axillary artery (n = 2, 6.5%), and femoral artery (n = 19, 6.2%), (p = 0.99). Incidence of stroke does not appear to differ among patients cannulated via the ascending aorta, axillary artery, or femoral artery. Ischemic stroke was the most common subtype of stroke.

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Funding

The authors received no specific funding for this work.

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Authors and Affiliations

  1. Department of Surgery, Division of Cardiothoracic Surgery, 177 Fort Washington Avenue, New York, NY, 10032, USA

    Mia Nishikawa, Hiroo Takayama, Yuji Kaku, Paul A. Kurlansky & Koji Takeda

  2. Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, NY, USA

    Mia Nishikawa, Amirali Masoumi & Justin Fried

  3. Department of Neurology, Columbia University Medical Center, New York, NY, USA

    Joshua Willey

  4. Department of Surgery, Center for Innovation and Outcomes Research, Columbia University Medical Center, New York, NY, USA

    Yuming Ning

  5. Department of Medicine, Division of Pulmonary and Critical Care Medicine, Columbia University Medical Center, New York, NY, USA

    Daniel Brodie

Authors
  1. Mia Nishikawa
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  2. Joshua Willey
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  3. Hiroo Takayama
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  4. Yuji Kaku
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  5. Yuming Ning
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  6. Paul A. Kurlansky
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  7. Daniel Brodie
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  8. Amirali Masoumi
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  9. Justin Fried
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  10. Koji Takeda
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Contributions

MN: conceptualization; data curation; formal analysis; investigation; methodology; writing—original draft; writing—review and editing. JW: investigation; methodology; writing—review and editing. HT: writing—review and editing. YK: writing—review and editing. YN: formal analysis; writing—original draft; writing—review and editing. PK: writing—review and editing. DB: writing—review and editing. AM: writing—review and editing. JF: writing—review and editing. KT: conceptualization; data curation; formal analysis; investigation; methodology; writing—original draft; writing—review and editing; supervision.

Corresponding authors

Correspondence to Mia Nishikawa or Koji Takeda.

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Conflict of interest

DB receives research support from ALung Technologies and he was previously on their medical advisory board. He has been on the medical advisory boards for Baxter, BREETHE, Xenios, and Hemovent. MN, JW, HT, YK, YN, PK, AM, JF, and KT have no conflicts of interest to disclose.

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Nishikawa, M., Willey, J., Takayama, H. et al. Stroke patterns and cannulation strategy during veno-arterial extracorporeal membrane support. J Artif Organs 25, 231–237 (2022). https://doi.org/10.1007/s10047-021-01300-5

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  • DOI: https://doi.org/10.1007/s10047-021-01300-5

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