Silva-Sieger F A, Salazar-Rojas L, Castillo-Meza A, Trillos-Leal R, Mendoza-Sánchez J A, Rodríguez-Parra V, Figueredo-Moreno A, Pizarro-Gómez C, Pabón-Moreno A, Rincón-Chivata A, López-Romero L A
Hospital Internacional de Colombia, Bucaramanga, Colombia.
Instituto Cardiovascular-FCV, Bucaramanga, Colombia.
Rev Neurol. 2021 Oct 1;73(7):241-248. doi: 10.33588/rn.7307.2020140.
ECMO is an advanced technique of ventilatory and circulatory support. However, it can be associated with neurological complications. The proposal is to describe the clinical characteristics and neurological complications profile in patients under ECMO support.
To descriptive a case series study. A descriptive and retrospective analysis and a bivariate analysis were performed in order to compare the main clinical variables of interest.
136 adults undergoing ECMO with an average age of 51 years (17-78) were evaluated. Neurological complications were observed in 51 patients (37.5%), corresponding to stroke 22 (16.17%), hypoxic encephalopathy 13 (9.5 %), cerebral hemorrhage (HIC) in 12 (8.8%) and subarachnoid hemorrhage (HSA) in 4 patients (2.9%). Seven (13.7%) of patients with neurological complications had seizures. Neurological complications occurred in 23.53% in venovenous ECMO and in 76.47% with veno-arterial ECMO (p = 0.86). The overall mortality was 51.47% (70/136) for all patients in ECMO and 64.7% (33/51) for the population with neurological complications. The mortality in stroke was 54.5% (12/22), 91.6% (11/12) in HIC and 100% (4) in HSA (p = 0.03). Mortality was higher in veno-arterial ECMO (77.14%) versus venous-venous ECMO (22.86% of total), (p = 0.015).
ECMO is a useful therapeutic tool in cases of high clinical severity. In our study, we identified a high rate of neurological complications that contribute to associated morbidity and mortality. Early neuroimaging studies in these cases could allow early detection of these complications.
体外膜肺氧合（ECMO）是一种先进的通气和循环支持技术。然而，它可能与神经系统并发症相关。本研究旨在描述接受ECMO支持的患者的临床特征和神经系统并发症情况。
采用病例系列描述性研究。进行描述性回顾分析和双变量分析，以比较主要的感兴趣临床变量。
对136例平均年龄51岁（17 - 78岁）接受ECMO治疗的成年人进行了评估。51例患者（37.5%）出现神经系统并发症，其中22例（16.17%）为中风，13例（9.5%）为缺氧性脑病，12例（8.8%）为脑出血（HIC），4例（2.9%）为蛛网膜下腔出血（HSA）。7例（13.7%）有神经系统并发症的患者发生了癫痫。在静脉 - 静脉ECMO中，神经系统并发症发生率为23.53%，在静脉 - 动脉ECMO中为76.47%（p = 0.86）。所有接受ECMO治疗的患者总体死亡率为51.47%（70/136），有神经系统并发症的患者死亡率为64.7%（33/51）。中风患者的死亡率为54.5%（12/22），脑出血患者为91.6%（11/12），蛛网膜下腔出血患者为100%（4例）（p = 0.03）。静脉 - 动脉ECMO的死亡率（77.14%）高于静脉 - 静脉ECMO（占总数的22.86%），（p = 0.015）。
ECMO在临床严重程度较高的病例中是一种有用的治疗工具。在我们的研究中，我们发现神经系统并发症发生率较高，这导致了相关的发病率和死亡率。对这些病例进行早期神经影像学检查可以早期发现这些并发症。
