Incidence and Predictors of Ischemic Cerebrovascular Stroke Among Patients on Extracorporeal Membrane Oxygenation Support

Introduction: There are scant data on the predictors of ischemic cerebrovascular stroke occurring during extracorporeal membrane oxygenation (ECMO). We investigated the incidence and predictors of ischemic stroke in subjects receiving ECMO support.

Methods: A retrospective chart review was conducted on consecutive adult subjects (>18 years of age) who received ECMO at Tampa General Hospital from 2007 to 2014 with the main outcome variable being the onset of radiologically confirmed ischemic stroke during ECMO support. We examined various risk factors for ischemic stroke including patients' demographics, clinical and laboratory variables, ECMO characteristics, type and amount of transfused blood products, and the indications necessitating ECMO support. To identify independent risk factors of ischemic stroke during ECMO and adjust for confounding variables, a multivariate logistic regression analysis was used.

Results: A total of 171 subjects received ECMO (mean age was 51 years, and 74.9% were male) for cardiac or pulmonary indications. Ten subjects (5.8%) developed ischemic stroke during ECMO. Cases with ischemic stroke had a higher mean pre-ECMO lactic acid level (10.6 ± 6.5 vs 6.3 ± 5.2 mmol/L, P= .039) and a higher frequency of pre-ECMO lactic acid level > 10 mmol/L (71.4% vs 24.8%, P = .019). Multivariate analysis identified that a pre-ECMO lactic acid greater than 10 mmol/L (odds ratio, 7.586; 95% CI, 1.396-41.223; P = .019) is an independent predictor of ischemic stroke occurring during ECMO support.

Conclusion: Ischemic stroke is not uncommon in subjects receiving ECMO support with independent risk factor being a pre-ECMO lactic acid greater than 10 mmol/L.