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. 2021 Dec 22;11(1):28.
doi: 10.3390/jcm11010028.

Association of COVID-19 with Intracranial Hemorrhage during Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome: A 10-Year Retrospective Observational Study

Tobias Pantel  1 , Kevin Roedl  2 , Dominik Jarczak  2 , Yuanyuan Yu  3 , Daniel Peter Frings  2 , Barbara Sensen  2 , Hans Pinnschmidt  4 , Alexander Bernhardt  5 , Bastian Cheng  6 , Iris Lettow  6 , Manfred Westphal  1 , Patrick Czorlich  1 , Stefan Kluge  2 , Marlene Fischer  2   3
Affiliations

Association of COVID-19 with Intracranial Hemorrhage during Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome: A 10-Year Retrospective Observational Study

Tobias Pantel et al. J Clin Med. .

Abstract

Extracorporeal membrane oxygenation (ECMO) is potentially lifesaving for patients with acute respiratory distress syndrome (ARDS) but may be accompanied by serious adverse events, including intracranial hemorrhage (ICRH). We hypothesized that ICRH occurs more frequently in patients with COVID-19 than in patients with ARDS of other etiologies. We performed a single-center retrospective analysis of adult patients treated with venovenous (vv-) ECMO for ARDS between January 2011 and April 2021. Patients were included if they had received a cranial computed tomography (cCT) scan during vv-ECMO support or within 72 h after ECMO removal. Cox regression analysis was used to identify factors associated with ICRH. During the study period, we identified 204 patients with vv-ECMO for ARDS, for whom a cCT scan was available. We observed ICRH in 35.4% (n = 17/48) of patients with COVID-19 and in 16.7% (n = 26/156) of patients with ARDS attributable to factors other than COVID-19. COVID-19 (HR: 2.945; 95%; CI: 1.079-8.038; p = 0.035) and carboxyhemoglobin (HR: 0.330; 95%; CI: 0.135-0.806; p = 0.015) were associated with ICRH during vv-ECMO. In patients receiving vv-ECMO, the incidence of ICRH is doubled in patients with COVID-19 compared to patients suffering from ARDS attributable to other causes. More studies on the association between COVID-19 and ICRH during vv-ECMO are urgently needed to identify risk patterns and targets for potential therapeutic interventions.

Keywords: COVID-19; acute respiratory distress syndrome; extracorporeal membrane oxygenation; hemorrhagic stroke; intracerebral hemorrhage; neurologic complications.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of patient selection during the study period (2011–2021). ARDS: acute respiratory distress syndrome. CCT: cranial computed tomography. CO2: carbon dioxide. Vv-/va-/vva-/vav-ECMO: veno-venous/veno-arterial/veno-veno-arterial/veno-arterio-venous extracorporeal membrane oxygenation. eCPR: extracorporeal cardiopulmonary resuscitation. a Patients, who did not receive a cCT scan during ECMO support or within the first 72 h after ECMO removal, were excluded.
Figure 2
Figure 2
Types of intraparenchymal hemorrhage according to the classification proposed by Prinz and colleagues [6]. Data are given in % for patients without (A) and with COVID-19-associated ARDS (B). No intraparenchymal hemorrhage (ICH) includes patients with intraventricular or subarachnoid hemorrhage, epidural or subdural hematoma.
See this image and copyright information in PMC

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