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Standardized Hemorrhagic Shock Induction Guided by Cerebral Oximetry and Extended Hemodynamic Monitoring in Pigs
Published on: May 21, 2019
Duration of ECMO Is an Independent Predictor of Intracranial Hemorrhage Occurring During ECMO Support
Hesham R Omar1, Mehdi Mirsaeidi, Devanand Mangar
1From the *Internal Medicine Department, Mercy Medical Center, Clinton, Iowa; †Division of Pulmonary, Critical Care, Sleep and Allergy, University of Miami, Miller School of Medical, Miami, Florida; ‡Section of Pulmonary, Department of Medicine, Miami VA Medical Center, Miami, Florida; §Tampa General Hospital, Tampa, Florida; ¶Department of Anesthesiology, TEAMHealth, Tampa, Florida; and ‖University of South Florida, Tampa, Florida.
Abstract:
We assessed the incidence and predictors of intracranial hemorrhage (ICH) occurring during extracorporeal membrane oxygenation (ECMO) support. Of 154 patients who received ECMO, 12 (7.8%) developed ICH. Patients with ICH had a longer ECMO duration (9.41 vs. 5.37 days, p = 0.007), and higher activated clotting time (activated clotting time, p= 0.016). They also experienced higher frequency of bleeding at other sites (p = 0.017) and required more platelet transfusion (p = 0.016). Multivariate analysis showed that a longer ECMO duration (odds ratio [OR] = 1.074, 95% confidence interval [CI] = 1.005-1.148, p = 0.035) is independently associated with the risk of ICH. We recommend routine neurological checks, monitoring of coagulation parameters, and attempt earlier rather than late weaning from ECMO whenever feasible.
