Neurological complications during veno-venous extracorporeal membrane oxygenation

Lorusso et al. studied 4,988 adult patients who underwent veno-venous extracorporeal membrane oxygenation (VV ECMO) using Extracorporeal Life Support Organization (ELSO) database to evaluate the incidence of neurological complication (1). They found that the neurological complications rate on VV ECMO was 7.1%. The majorities of these neurological complications were intracranial bleed (42.5%), brain death (23.5%), and ischemic stroke (19.9%). The incidence of neurological complications while on VV ECMO decreased over time from 9.5–14.3% in the 1990s to 6.7–7.9% from the year 2000 forwards. The pre-ECMO risk factors for neurological complications during VV ECMO were reported to be cardiac arrest, continuous renal replacement therapy (CRRT) and hyperbilirubinemia. Once neurological complications occurred during VV ECMO, less than 25% of patients survived to discharge (mortality rate 75.8% in patients with neurological injury), while those who without neurological complication had a discharge rate from hospital of 63%.