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Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Extracorporeal Membrane Oxygenation Timing and Intracranial Hemorrhage in Coronavirus Patients: Insights for Future
Gabriel Saiydoun1, Blanche Bapst2, François Bagate3
1Department of Cardiac Surgery, Henri Mondor University Hospital, APHP, Créteil, France; Department of Cardiac Surgery, Pitié Salpetrière University Hospital, Sorbonne University, APHP, Paris, France.
Background:
Delayed initiation of venovenous extracorporeal membrane oxygenation (VV-ECMO) may increase the risk of intracranial hemorrhage (ICH) in coronavirus patients. This study aimed to investigate the relationship between ECMO timing and the occurrence of ICH in this critically ill population, providing insights for future epidemic management.
Methods:
This retrospective study included coronavirus patients treated with VV-ECMO from March to June 2020. ICH was assessed using head computed tomography scans reviewed by a senior neurosurgeon and neuroradiologist.
Results:
Among 43 patients (median age: 55 years, 7 women), 19% (n = 8) developed ICH during VV-ECMO. In 10 patients, no ICH was detected, and 25 patients had no imaging available. Kaplan-Meier analysis revealed a longer delay from hospital admission to VV-ECMO initiation in patients with ICH (P = 0.03). Patients with ICH had lower minute ventilation before cannulation (7.7 L/minute vs. 12.1 L/minute, P = 0.04) and higher arterial lactate levels (3.0 mmol/L vs. 1.9 mmol/L, P = 0.03). Elevated serum bilirubin levels were also potentially linked to ICH (P = 0.07).
Conclusions:
Later extracorporeal membrane oxygenation initiation, when combined with signs of respiratory and metabolic decompensation, was associated with a higher risk of ICH in coronavirus patients. These findings emphasize the importance of timely extracorporeal membrane oxygenation intervention to reduce ICH risks and inform future epidemic response strategies.
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