ORCID Profile
0000-0002-3870-9811
Current Organisation
Johns Hopkins Hospital
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Publisher: Cold Spring Harbor Laboratory
Date: 13-03-2022
DOI: 10.1101/2022.03.10.22272203
Abstract: Acute brain injury remains common after extracorporeal cardiopulmonary resuscitation. Using a large international multicenter cohort, we investigated the impact of peri-cannulation arterial oxygen (PaO 2 ) and carbon dioxide (PaCO 2 ) on ABI occurrence. Retrospective cohort study. Data in the Extracorporeal Life Support Organization Registry from 2009 to 2020. Adult patients (≥18 years old) who underwent extracorporeal cardiopulmonary resuscitation. None. Of 3,125 patients with extracorporeal cardiopulmonary resuscitation (median age=58, 69% male), 488 (16%) experienced at least one form of acute brain injury, which included ischemic stroke, intracranial hemorrhage, seizures, and brain death. 217 (7%) experienced ischemic stroke and 88 (3%) experienced intracranial hemorrhage. The registry collects two blood gas data pre- (6 hours before) and on- (24 hours after) extracorporeal membrane oxygenation (ECMO) cannulation. Blood gas parameters were classified as: hypoxia ( mmHg), normoxia (60-119mmHg), and mild (120-199mmHg), moderate (200-299mmHg), and severe hyperoxia (≥300mmHg) hypocarbia ( mmHg), normocarbia (35-44mmHg), mild (45-54mmHg) and severe hypercarbia (≥55mmHg). In multivariable logistic regression analysis, pre-ECMO hypoxia (aOR=1.46, 95%CI: 1.03-2.08, p=0.04) and on-ECMO severe hyperoxia (aOR=1.55, 95%CI: 1.02-2.36, p=0.04) were associated with composite ABI. Also, on-ECMO severe hyperoxia was associated with intracranial hemorrhage (aOR=1.88, 95%CI: 1.02-3.47, p=0.04) and in-hospital mortality (aOR=3.51, 95%CI: 1.98-6.22, p .001). Pre- and on-ECMO PaCO 2 levels were not significantly associated with composite ABI or mortality, though mild hypercarbia pre- and on-ECMO were protective of ischemic stroke and intracranial hemorrhage, respectively. Early severe hyperoxia (≥300mmHg) on ECMO was a significant risk factor for acute brain injury and mortality for patients undergoing extracorporeal cardiopulmonary resuscitation. Careful consideration should be given in early oxygen delivery in ECPR patients who are at risk of reperfusion injury.
Publisher: Elsevier BV
Date: 04-2023
DOI: 10.1016/J.HEALUN.2022.10.019
Abstract: Acute brain injury (ABI) remains common after extracorporeal cardiopulmonary resuscitation (ECPR). Using a large international multicenter cohort, we investigated the impact of peri-cannulation arterial oxygen (PaO We retrospectively analyzed adult (≥18 years old) ECPR patients in the Extracorporeal Life Support Organization registry from 1/2009 through 12/2020. Composite ABI included ischemic stroke, intracranial hemorrhage (ICH), seizures, and brain death. The registry collects 2 blood gas data pre- (6 hours) and post- (24 hours) cannulation. Blood gas parameters were classified as: hypoxia (<60mm Hg), normoxia (60-119mm Hg), and mild (120-199mm Hg), moderate (200-299mm Hg), and severe hyperoxia (≥300mm Hg) hypocarbia (<35mm Hg), normocarbia (35-44mm Hg), mild (45-54mm Hg) and severe hypercarbia (≥55mm Hg). Missing values were handled using multiple imputation. Multivariable logistic regression analysis was used to assess the relationship of PaO Of 3,125 patients with ECPR intervention (median age=58, 69% male), 488 (16%) experienced ABI (7% ischemic stroke 3% ICH). In multivariable analysis, on-ECMO moderate (aOR=1.42, 95%CI: 1.02-1.97) and severe hyperoxia (aOR=1.59, 95%CI: 1.20-2.10) were associated with composite ABI. Additionally, severe hyperoxia was associated with ischemic stroke (aOR=1.63, 95%CI: 1.11-2.40), ICH (aOR=1.92, 95%CI: 1.08-3.40), and in-hospital mortality (aOR=1.58, 95%CI: 1.21-2.06). Mild hypercarbia pre-ECMO was protective of composite ABI (aOR=0.61, 95%CI: 0.44-0.84) and ischemic stroke (aOR=0.56, 95%CI: 0.35-0.89). Early severe hyperoxia (≥300mm Hg) on ECMO was a significant risk factor for ABI and mortality. Careful consideration should be given in early oxygen delivery in ECPR patients who are at risk of reperfusion injury.
Location: United States of America
Location: United States of America
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Steven Keller.