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Published on: March 31, 2016
Prevalence and Neurological Outcomes of Comatose Patients With Extracorporeal Membrane Oxygenation
Cheng-Yuan Feng1, Anna Kolchinski2, Shrey Kapoor2
1Division of Neurosciences Critical Care, Departments of Neurology and Neurosurgery, and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Critical Care Medicine and TriHealth Neuroscience Institute, Cincinnati, OH.
Objectives:
To investigate prevalence, risk factors, and in-hospital outcomes of comatose extracorporeal membrane oxygenation (ECMO) patients.
Design:
Retrospective observational.
Setting:
Tertiary academic hospital.
Participants:
Adults received venoarterial (VA) or venovenous (VV) ECMO support between November 2017 and April 022.
Interventions:
None.
Measurements And Main Results:
We defined 24-hour off sedation as no sedative infusion (except dexmedetomidine) or paralytics administration over a continuous 24-hour period while on ECMO. Off-sedation coma (comaoff) was defined as a Glasgow Coma Scale score of ≤8 after achieving 24-hour off sedation. On-sedation coma (comaon) was defined as a Glasgow Coma Scale score of ≤8 during the entire ECMO course without off sedation for 24 hours. Neurological outcomes were assessed at discharge using the modified Rankin scale (good, 0-3; poor, 4-6). We included 230 patients (VA-ECMO 143, 65% male); 24-hour off sedation was achieved in 32.2% VA-ECMO and 26.4% VV-ECMO patients. Among all patients off sedation for 24 hours (n = 69), 56.5% VA-ECMO and 52.2% VV-ECMO patients experienced comaoff. Among those unable to be sedation free for 24 hours (n = 161), 50.5% VA-ECMO and 17.2% VV-ECMO had comaon. Comaoff was associated with poor outcomes (p < 0.05) in VA-ECMO and VV-ECMO groups, whereas comaon only impacted the VA-ECMO group outcomes. In a multivariable analysis, requirement of renal replacement therapy was an independent risk factor for comaoff after adjusting for ECMO configuration, after adjusting for ECMO configuration, acute brain injury, pre-ECMO partial pressure of oxygen in arterial blood, partial pressure of carbon dioxide in arterial blood, pH, and bicarbonate level (worst value within 24 hours before cannulation).
Conclusions:
Comaoff was common and associated with poor outcomes at discharge. Requirement of renal replacement therapy was an independent risk factor.
