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Patterns and Predictors of Extra-Corporeal Membrane Oxygenation Related Cerebral Microbleeds
Karan Topiwala1, Haitham Hussein1, Kamran Masood1
1University of Minnesota, 516 Delaware St SE., 12-100 Phillips Wangensteen Building, Minneapolis, MN 55455, USA.
Objectives:
Recent case-reports have described an atypical cerebral microbleed (CMB) topography after extracorporeal membrane oxygenation (ECMO). The objective of this study was to examine the prevalence, radiographic patterns, and clinical correlates of possibly-ECMO-related (PER) CMB.
Materials And Methods:
We performed a retrospective study of 307 consecutive patients receiving ECMO support at our tertiary-care University Hospital (2013-2018). PER CMB were defined as CMB present in corpus-callosum and/or middle cerebellar peduncle with/without involvement of other lobar/deep structures. Leukoaraiosis was quantified using the Wahlund age-related white matter changes scale. Patient characteristics were compared between cohorts with and without PER CMB.
Results:
Forty patients (median age 60 years; 33% vv-ECMO and 67% va-ECMO) received at-least one MRI-brain within 3 months of ECMO support. CMB were present in 77.5% (n = 31) patients with 39% (n = 12), 17% (n = 5), and 44% (n = 14) having low (< 10 CMB), moderate (10-30 CMB), and high (> 30 CMB) burden respectively. Among CMB-positive patients, 71% (n = 22) had PER CMB, with 91% of such cases demonstrating involvement of splenium. Leukoaraiosis did not corelate to PER CMB presence (p = 0.267) or burden (ρ = 0.09). Patients with PER CMB had higher rates of ischemic stroke (50 vs. 33%), intracranial hemorrhage (41 vs. 17%), and all-cause mortality (27 vs. 17%); with survivors demonstrating no differences in their discharge disposition or modified Rankin Score.
Conclusions:
Post-ECMO cerebral microbleeds have a distinct distribution pattern that commonly involves the splenium of corpus-callosum. Their etiopathogenesis may be independent of microvascular lipohyalinosis. This requires further study in a larger sample-size.
Insights
Extracorporeal membrane oxygenation (ECMO) can cause distinct cerebral microbleeds (CMB), often in the corpus callosum. These possibly-ECMO-related CMB are associated with increased stroke, hemorrhage, and mortality risks.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Radiology
Background:
- Case reports suggest atypical cerebral microbleed (CMB) topography following extracorporeal membrane oxygenation (ECMO).
- Understanding the characteristics and clinical impact of these CMB is crucial for patient management.
Purpose of the Study:
- To investigate the prevalence, radiographic patterns, and clinical correlates of possibly-ECMO-related (PER) CMB.
- To identify specific locations and associated risk factors for CMB after ECMO.
Main Methods:
- Retrospective analysis of 307 patients undergoing ECMO support.
- Defined PER CMB as those in the corpus callosum and/or middle cerebellar peduncle.
- Compared patient characteristics between those with and without PER CMB.
Main Results:
- 31 patients (77.5%) had CMB within 3 months of ECMO; 22 (71%) had PER CMB, predominantly in the splenium of the corpus callosum.
- PER CMB were associated with higher rates of ischemic stroke (50% vs. 33%) and intracranial hemorrhage (41% vs. 17%).
- Higher all-cause mortality was observed in patients with PER CMB (27% vs. 17%).
Conclusions:
- Post-ECMO CMB exhibit a distinct pattern, frequently involving the corpus callosum splenium.
- The etiopathogenesis of these CMB may be independent of microvascular lipohyalinosis.
- Further research with larger sample sizes is warranted to elucidate the mechanisms and implications of PER CMB.
