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Cerebrovascular Complications of COVID-19 on Venovenous Extracorporeal Membrane Oxygenation

Akram M Zaaqoq1, Matthew J Griffee2, Thu-Lan Kelly3

  • 1Department of Critical Care Medicine, MedStar Washington Hospital Center, Georgetown University, Washington, DC.

Critical Care Medicine
|April 3, 2023
PubMed

Insights

Obesity and pre-extracorporeal membrane oxygenation (ECMO) vasopressor use increase stroke risk in COVID-19 patients on venovenous ECMO. Changes in carbon dioxide and oxygen levels post-ECMO also indicate higher stroke risk and mortality.

Area of Science:

  • Critical care medicine
  • Neurology
  • Infectious diseases

Background:

  • Cerebrovascular complications in COVID-19 patients requiring venovenous extracorporeal membrane oxygenation (ECMO) are not well-characterized.
  • Understanding stroke prevalence and risk factors in this population is crucial for improving patient outcomes.

Purpose of the Study:

  • To determine the prevalence and identify risk factors for stroke in adult COVID-19 patients supported by venovenous ECMO.
  • To analyze the association between pre-ECMO and early post-ECMO physiological parameters and stroke development.

Main Methods:

  • Analysis of prospectively collected data from the COVID-19 Critical Care Consortium (COVID Critical) registry.
  • Inclusion of 595 adult COVID-19 patients on venovenous ECMO.
  • Utilized univariable and multivariable survival modeling (Cox proportional hazards and Fine-Gray models) with competing risks.

Main Results:

  • Stroke occurred in 7.2% of patients, with 83.7% being hemorrhagic.
  • Obesity (aHR, 2.19) and pre-ECMO vasopressor use (aHR, 2.37) were significantly associated with increased stroke risk.
  • Stroke patients exhibited greater relative decreases in PaCO2 and moderate increases in PaO2 within 48 hours of ECMO initiation.
  • In-hospital mortality was substantially higher in patients who experienced stroke (79%) compared to those who did not (45%).

Conclusions:

  • Obesity and pre-ECMO vasopressor use are significant risk factors for stroke in COVID-19 patients on venovenous ECMO.
  • Specific changes in PaCO2 and PaO2 within 48 hours of ECMO initiation are associated with stroke development.
  • Stroke in this population portends a significantly worse prognosis, underscoring the need for vigilant monitoring and management.
Abstract

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