Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 Feb;31(2):292-298.
doi: 10.1016/j.hlc.2021.10.007. Epub 2021 Oct 28.

Neurological Complications in COVID-19 Patients With ECMO Support: A Systematic Review and Meta-Analysis

Nivedha V Kannapadi  1 , Meghana Jami  1 , Lavienraj Premraj  2 , Eric W Etchill  3 , Katherine Giuliano  3 , Errol L Bush  3 , Bo Soo Kim  4 , Stella Seal  5 , Glenn Whitman  3 , Sung-Min Cho  6
Affiliations
Meta-Analysis

Neurological Complications in COVID-19 Patients With ECMO Support: A Systematic Review and Meta-Analysis

Nivedha V Kannapadi et al. Heart Lung Circ. 2022 Feb.

Abstract

Background: Patients with Coronavirus disease 2019 (COVID-19)-related acute respiratory disease (ARDS) increasingly receive extracorporeal membrane oxygenation (ECMO) support. While ECMO has been shown to increase risk of stroke, few studies have examined this association in COVID-19 patients.

Objective: We conducted a systematic review to characterise neurological events during ECMO support in COVID-19 patients.

Design: Systematic review of cohort and large case series of COVID-19 patients who received ECMO support.

Data sources: Studies retrieved from PubMed, EMBASE, Cochrane, Cochrane COVID-19 Study Register, Web of Science, Scopus, Clinicaltrials.gov, and medRχiv from inception to November 11, 2020.

Eligibility criteria: Inclusion criteria were a) Adult population (>18 year old); b) Positive PCR test for SARS-CoV-2 with active COVID-19 disease; c) ECMO therapy due to COVID-19 ARDS; and d) Neurological events and outcome described while on ECMO support. We excluded articles when no details of neurologic events were available.

Results: 1,322 patients from 12 case series and retrospective cohort studies were included in our study. The median age was 49.2, and 75% (n=985) of the patients were male. Diabetes mellitus and dyslipidaemia were the most common comorbidities (24% and 20%, respectively). Most (95%, n=1,241) patients were on venovenous ECMO with a median P:F ratio at the time of ECMO cannulation of 69.1. The prevalence of intracranial haemorrhage (ICH), ischaemic stroke, and hypoxic ischaemic brain injury (HIBI) was 5.9% (n=78), 1.1% (n=15), and 0.3% (n=4), respectively. The overall mortality of the 1,296 ECMO patients in the 10 studies that reported death was 36% (n=477), and the mortality of the subset of patients who had a neurological event was 92%.

Conclusions: Neurological injury is a concern for COVID-19 patients who receive ECMO. Further research is required to explore how neuromonitoring protocols can inform tailored anticoagulation management and improve survival in COVID-19 patients with ECMO support.

Keywords: COVID-19; ECMO; Intracranial haemorrhage; Stroke.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flow diagram for systematic review of COVID-19 patients on ECMO developing neurological complications. Abbreviation: ECMO, extracorporeal membrane oxygenation.
See this image and copyright information in PMC

References

    1. Badulak J., Antonini M.V., Stead C.M., Shekerdemian L., Raman L., Paden M.L., et al. Extracorporeal membrane oxygenation for COVID-19: updated 2021 guidelines from the extracorporeal Life support Organization. ASAIO J. 2021;67(5):485–495. - PMC - PubMed
    1. Barbaro R.P., MacLaren G., Boonstra P.S., Iwashyna T.J., Slutsky A.S., Fan E., et al. Extracorporeal membrane oxygenation support in COVID-19: an international cohort study of the Extracorporeal Life Support Organization registry. Lancet. 2020;396(10257):1071–1078. - PMC - PubMed
    1. Migdady I., Rice C., Deshpande A., Hernandez A.V., Price C., Whitman G.J., et al. Brain injury and neurologic outcome in patients undergoing extracorporeal cardiopulmonary resuscitation: a systematic review and meta-analysis. Crit Care Med. 2020;48(7):e611. - PubMed
    1. Shoskes A., Migdady I., Rice C., Hassett C., Deshpande A., Price C., et al. Brain injury is more common in venoarterial extracorporeal membrane oxygenation than venovenous extracorporeal membrane oxygenation: a systematic review and meta-analysis. Crit Care Med. 2020;48(12):1799–1808. - PubMed
    1. Bernard I., Limonta D., Mahal L.K., Hobman T.C. Endothelium infection and dysregulation by SARS-CoV-2: evidence and caveats in COVID-19. Viruses [Internet] 2020;13(1):29. - PMC - PubMed