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Neurologic Complications of Patients With COVID-19 Requiring Extracorporeal Membrane Oxygenation: A Systematic Review

Cathy Meng Fei Li1,2, Xiaoxiao Densy Deng2, Yu Fei Ma3

  • 1Department of Clinical Neurological Sciences, Western University, London, ON, Canada.

Critical Care Explorations
|March 31, 2023
PubMed

Insights

Patients with COVID-19 needing extracorporeal membrane oxygenation (ECMO) frequently experience intracranial hemorrhage (ICH). Neurologic complications significantly increase mortality risk in these critically ill patients.

Area of Science:

  • Neurology
  • Critical Care Medicine
  • Infectious Diseases

Background:

  • Severe COVID-19 often necessitates extracorporeal membrane oxygenation (ECMO).
  • Neurologic complications are a significant concern in ECMO patients.
  • Intracranial hemorrhage (ICH) is a potential complication in this population.

Purpose of the Study:

  • To determine the frequency of intracranial hemorrhage (ICH) in COVID-19 patients on ECMO.
  • To assess the incidence of ischemic stroke and the association between anticoagulation and ICH.
  • To evaluate the impact of neurologic complications on in-hospital mortality.

Main Methods:

  • Systematic review and meta-analysis of studies published up to March 15, 2022.
  • Inclusion of adult patients with SARS-CoV-2 infection requiring ECMO.
  • Random-effects model used for meta-analysis of pooled data.

Main Results:

  • The frequency of ICH was 11% in patients on venovenous ECMO, with intraparenchymal hemorrhage most common.
  • Ischemic stroke occurred in 2% of patients; higher anticoagulation targets did not correlate with increased ICH.
  • In-hospital mortality was 37%, and neurologic complications more than doubled mortality risk (RR 2.24).

Conclusions:

  • COVID-19 patients on venovenous ECMO face a high risk of ICH.
  • Neurologic complications substantially elevate the risk of death in this cohort.
  • Clinicians must maintain vigilance for ICH in ECMO-supported COVID-19 patients.

Keywords:
COVID-19extracorporeal membrane oxygenationneurologic complications

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