Li Cathy Meng Fei, Densy Deng Xiaoxiao, Ma Yu Fei, Dawson Emily, Li Carol, Wang Dong Yao, Huong Lynn, Gofton Teneille, Nagpal Atul Dave, Slessarev Marat
Department of Clinical Neurological Sciences, Western University, London, ON, Canada.
Schulich School of Medicine and Dentistry, London, ON, Canada.
Crit Care Explor. 2023 Mar 27;5(4):e0887. doi: 10.1097/CCE.0000000000000887. eCollection 2023 Apr.
In COVID-19 patients requiring extracorporeal membrane oxygenation (ECMO), our primary objective was to determine the frequency of intracranial hemorrhage (ICH). Secondary objectives were to estimate the frequency of ischemic stroke, to explore association between higher anticoagulation targets and ICH, and to estimate the association between neurologic complications and in-hospital mortality.
We searched MEDLINE, Embase, PsycINFO, Cochrane, and MedRxiv databases from inception to March 15, 2022.
We identified studies that described acute neurological complications in adult patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection requiring ECMO.
Two authors independently performed study selection and data extraction. Studies with 95% or more of its patients on venovenous or venoarterial ECMO were pooled for meta-analysis, which was calculated using a random-effects model.
Fifty-four studies ( = 3,347) were included in the systematic review. Venovenous ECMO was used in 97% of patients. Meta-analysis of ICH and ischemic stroke on venovenous ECMO included 18 and 11 studies, respectively. The frequency of ICH was 11% (95% CI, 8-15%), with intraparenchymal hemorrhage being the most common subtype (73%), while the frequency of ischemic strokes was 2% (95% CI, 1-3%). Higher anticoagulation targets were not associated with increased frequency of ICH ( = 0.06). In-hospital mortality was 37% (95% CI, 34-40%) and neurologic causes ranked as the third most common cause of death. The risk ratio of mortality in COVID-19 patients with neurologic complications on venovenous ECMO compared with patients without neurologic complications was 2.24 (95% CI, 1.46-3.46). There were insufficient studies for meta-analysis of COVID-19 patients on venoarterial ECMO.
COVID-19 patients requiring venovenous ECMO have a high frequency of ICH, and the development of neurologic complications more than doubled the risk of death. Healthcare providers should be aware of these increased risks and maintain a high index of suspicion for ICH.
在需要体外膜肺氧合（ECMO）的新冠肺炎患者中，我们的主要目标是确定颅内出血（ICH）的发生率。次要目标是估计缺血性中风的发生率，探讨较高抗凝目标与ICH之间的关联，以及估计神经系统并发症与住院死亡率之间的关联。
我们检索了从数据库建立至2022年3月15日的MEDLINE、Embase、PsycINFO、Cochrane和MedRxiv数据库。
我们纳入了描述需要ECMO的严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染成年患者急性神经系统并发症的研究。
两位作者独立进行研究选择和数据提取。将95%或更多患者接受静脉-静脉或静脉-动脉ECMO治疗的研究汇总进行荟萃分析，采用随机效应模型计算。
系统评价纳入了54项研究（n = 3347）。97%的患者使用静脉-静脉ECMO。对静脉-静脉ECMO上ICH和缺血性中风的荟萃分析分别纳入了18项和11项研究。ICH的发生率为11%（95%CI，8 - 15%），脑实质内出血是最常见的亚型（73%），而缺血性中风的发生率为2%（95%CI, 1 - 3%）。较高的抗凝目标与ICH发生率增加无关（P = 0.06）。住院死亡率为37%（95%CI，34 - 40%），神经系统原因是第三大常见死因。与无神经系统并发症的患者相比，静脉-静脉ECMO上有神经系统并发症的新冠肺炎患者的死亡风险比为2.24（95%CI，1.46 - 3.46）。关于接受静脉-动脉ECMO治疗的新冠肺炎患者进行荟萃分析的研究不足。
需要静脉-静脉ECMO的新冠肺炎患者ICH发生率高，神经系统并发症的发生使死亡风险增加一倍多。医疗服务提供者应意识到这些增加的风险，并对ICH保持高度怀疑。
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