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

Area of Science:

• Cardiology
• Neurology
• Critical Care Medicine

Background:

• Veno-arterial extracorporeal membrane support (VA-ECMO) is a critical intervention for cardiogenic shock.
• Stroke is a severe complication for patients on VA-ECMO.
• The impact of arterial cannulation site on stroke risk requires further elucidation.

Purpose of the Study:

• To investigate the association between VA-ECMO arterial cannulation sites and the occurrence and patterns of stroke.
• To compare stroke incidence across different cannulation strategies.

Main Methods:

• Retrospective review of 414 patients receiving VA-ECMO for cardiogenic shock (March 2007 - May 2018).
• Patients categorized by arterial cannulation site: ascending aorta, axillary artery, or femoral artery.
• Analysis of stroke rates, subtypes, and locations via neuroimaging during and after VA-ECMO.

Main Results:

• A total of 26 patients (6.3%) developed stroke lesions.
• Stroke incidence was comparable across cannulation strategies: aorta (6.5%), axillary artery (6.5%), and femoral artery (6.2%) (p=0.99).
• Ischemic stroke was the most frequent subtype (64%), followed by hemorrhagic transformation (20%) and hemorrhagic stroke (16%).

Conclusions:

• The arterial cannulation site for VA-ECMO does not appear to influence the incidence of stroke.
• Ischemic stroke is the predominant stroke subtype in patients undergoing VA-ECMO.
• Further research may explore other factors contributing to stroke in this patient population.