Department of Critical Care Medicine The First Affiliated Hospital, Zhejiang University School of Medicine Hangzhou China.
J Am Heart Assoc. 2024 Oct 15;13(20):e037029. doi: 10.1161/JAHA.124.037029. Epub 2024 Oct 11.
Cerebral microbleeds (CMBs) are common and varied in patients receiving extracorporeal membrane oxygenation (ECMO). Here, the authors describe CMB findings in patients receiving ECMO and their association with clinical factors.
A total of 138 patients receiving ECMO were enrolled and categorized as venovenous and venoarterial. Blood coagulation profiles during ECMO support and Glasgow Coma Scale (GCS) scores within 7 days were recorded. Patients with CMBs exhibited prolonged activated clotting time (<0.001), decreased fibrinogen levels (<0.001), reduced platelet counts (<0.001), and extended prothrombin time (<0.001). A significant correlation (<0.05) was observed between the presence of CMBs and most coagulation parameters among all patients. Patients with venoarterial ECMO had significantly higher activated partial thromboplastin time, activated clotting time, and prothrombin time compared with those with venovenous ECMO (all <0.05). Patients with a less severe CMB burden exhibited higher GCS scores and better neurological injury outcomes at both 7 and 90 days. CMB burden in all patients with ECMO was significantly correlated (<0.05) with most blood coagulation profiles and neurological injury.
CMB burdens after ECMO are common, varied, and associated with a variety of clinical conditions. These findings may guide ECMO management.
体外膜肺氧合（ECMO）治疗的患者中常见脑微出血（CMBs），且其表现多样。在此，作者描述了 ECMO 治疗患者的 CMB 表现及其与临床因素的关系。
共纳入 138 例行 ECMO 的患者，并分为静脉-静脉和静脉-动脉模式。记录 ECMO 支持期间的凝血特征和 7 天内的格拉斯哥昏迷量表（GCS）评分。有 CMB 的患者表现为活化凝血时间延长（<0.001）、纤维蛋白原水平降低（<0.001）、血小板计数减少（<0.001）和凝血酶原时间延长（<0.001）。所有患者中，CMB 的存在与大多数凝血参数之间存在显著相关性（<0.05）。与静脉-静脉 ECMO 患者相比，静脉-动脉 ECMO 患者的活化部分凝血活酶时间、活化凝血时间和凝血酶原时间显著升高（均<0.05）。CMB 负担较轻的患者在第 7 天和第 90 天的 GCS 评分更高，神经损伤结局更好。所有 ECMO 患者的 CMB 负担与大多数凝血特征和神经损伤显著相关（<0.05）。
ECMO 后 CMB 很常见，且表现多样，与多种临床情况相关。这些发现可能有助于指导 ECMO 管理。
