Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Germany.
Department of Anesthesiology and Operative Intensive Care Medicine, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
Neurosurg Rev. 2021 Oct;44(5):2879-2888. doi: 10.1007/s10143-020-01471-4. Epub 2021 Jan 23.
Intracerebral hemorrhage (ICH) is a devastating complication in patients treated with extracorporeal membrane oxygenation (ECMO) due to respiratory or cardiac issues. Neurosurgical evaluation and management of such cases has only insufficiently been studied. We conducted a retrospective, cohort study of adult patients treated with ECMO between January 2007 and January 2017 in a tertiary healthcare center. Demographics, clinical data, coagulation status, ICH characteristics, and treatment modalities were analyzed. The primary outcome parameter was defined as mortality caused by ICH during ECMO. 525 patients with ECMO therapy were eligible for analysis. An overall incidence for any type of intracranial bleeding of 12.3% was found. Small hemorrhages accounted for 6.4% and acute subdural and epidural hematoma for 1.2%. Twenty-four (4.6%) patients developed ICH, and 11 patients (46%) died due to the ICH. Mortality was significantly higher in patients with larger ICH volumes (86.8 ± 34.8 ml vs 9.9 ± 20.3 ml, p < 0.001), intraventricular hemorrhage (83% vs 8%, p = 0.01), and a fluid level inside the ICH (75% vs 31%, p = 0.04). All patients were classified according to the bleeding pattern on the initial CT scan into 3 types. Patients with type 1 bleeding were statistically more likely to die (p < 0.001). In 15 out of 24 patients (63%), correction of the coagulation status was possible within 12 h after ICH onset. Seven out of 9 patients (78%) without early coagulation correction died compared to 2 out of 15 patients (13%), in whom early coagulation correction was successful (p = 0.01). This is the first study evaluating the course and management of patients experiencing an ICH under ECMO therapy and establishing an ICH classification based on the bleeding patterns. Early correction of the coagulation is of paramount importance in the treatment of these patients.
颅内出血（ICH）是接受体外膜肺氧合（ECMO）治疗的患者因呼吸或心脏问题而发生的一种破坏性并发症。此类病例的神经外科评估和管理研究甚少。我们对 2007 年 1 月至 2017 年 1 月在三级医疗中心接受 ECMO 治疗的成年患者进行了回顾性队列研究。分析了人口统计学、临床数据、凝血状态、ICH 特征和治疗方式。主要结局参数定义为 ECMO 期间 ICH 导致的死亡率。525 名接受 ECMO 治疗的患者符合分析条件。任何类型的颅内出血发生率为 12.3%。小出血占 6.4%，急性硬膜下和硬膜外血肿占 1.2%。24 例（4.6%）患者发生 ICH，11 例（46%）患者因 ICH 死亡。ICH 体积较大的患者死亡率显著更高（86.8±34.8 ml 比 9.9±20.3 ml，p<0.001）、存在脑室内出血（83%比 8%，p=0.01）和 ICH 内有液平（75%比 31%，p=0.04）。所有患者根据初始 CT 扫描上的出血模式分为 3 型。1 型出血患者的死亡率明显更高（p<0.001）。在 24 例患者中，有 15 例（63%）ICH 发病后 12 h 内凝血状态得到纠正。在未早期纠正凝血的 9 例患者中，有 7 例（78%）死亡，而在 15 例成功早期纠正凝血的患者中，只有 2 例（13%）死亡（p=0.01）。这是第一项评估 ECMO 治疗下发生 ICH 的患者的病程和管理，并基于出血模式建立 ICH 分类的研究。早期纠正凝血对这些患者的治疗至关重要。
