Incidence and risk factors associated with stroke when utilizing peripheral VA-ECMO

Area of Science:

• Cardiology
• Neurology
• Critical Care Medicine

Background:

• Mechanical circulatory support with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has transformed cardiogenic shock management.
• Neurological complications are a major cause of morbidity and mortality in VA-ECMO patients, limiting its use.

Purpose of the Study:

• To identify risk factors for stroke in patients undergoing peripheral VA-ECMO.
• To analyze in-hospital outcomes up to 30 days post-stroke in this patient population.

Main Methods:

• A single-center retrospective case-control study included 244 adult patients on peripheral VA-ECMO from January 2018 to September 2022.
• Patients who developed stroke (n=36) were compared to those who did not, using multivariable logistic regression to identify stroke risk factors.
• In-hospital outcomes, including mortality, were assessed up to 30 days.

Main Results:

• 14.7% of patients developed stroke on VA-ECMO, with 55.6% being ischemic and 44.4% hemorrhagic.
• Independent risk factors for stroke included P2Y12 antagonist use (aOR 2.70), limb ischemia (aOR 4.41), and blood transfusion (aOR 8.55).
• Female sex trended towards significance (aOR 2.19), while age was not a significant factor. Stroke development did not impact VA-ECMO duration, hospital stay, or 30-day mortality.

Conclusions:

• VA-ECMO is associated with a substantial risk of neurological complications, specifically stroke.
• Early identification and management of stroke are critical, as risk factors like limb ischemia and P2Y12 antagonist use are modifiable.
• Further clinical trials and multicenter studies are needed to develop strategies for mitigating stroke risk in VA-ECMO patients.