Details

Autor(en) / Beteiligte

• Lockie, Christopher J A
• Gillon, Stuart A
• Barrett, Nicholas A
• Taylor, Daniel
• Mazumder, Asif
• Paramesh, Kaggere
• Rowland, Katie
• Daly, Kathleen
• Camporota, Luigi
• Meadows, Christopher I S
• Glover, Guy W
• Ioannou, Nicholas
• Langrish, Christopher J
• Tricklebank, Stephen
• Retter, Andrew
• Wyncoll, Duncan L A

Titel

Severe Respiratory Failure, Extracorporeal Membrane Oxygenation, and Intracranial Hemorrhage

Ist Teil von

• Critical care medicine, 2017-10, Vol.45 (10), p.1642-1649

Ort / Verlag

United States: Copyright by by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc

Erscheinungsjahr

2017

Quelle

MEDLINE

Beschreibungen/Notizen

• OBJECTIVES:For patients supported with veno-venous extracorporeal membrane oxygenation, the occurrence of intracranial hemorrhage is associated with a high mortality. It is unclear whether intracranial hemorrhage is a consequence of the extracorporeal intervention or of the underlying severe respiratory pathology. In a cohort of patients transferred to a regional severe respiratory failure center that routinely employs admission brain imaging, we sought 1) the prevalence of intracranial hemorrhage; 2) survival and neurologic outcomes; and 3) factors associated with intracranial hemorrhage. DESIGN:A single-center, retrospective, observational cohort study. SETTING:Tertiary referral severe respiratory failure center, university teaching hospital. PATIENTS:Patients admitted between December 2011 and February 2016. INTERVENTION:None. MEASUREMENTS AND MAIN RESULTS:Three hundred forty-two patients were identified250 managed with extracorporeal support and 92 managed using conventional ventilation. The prevalence of intracranial hemorrhage was 16.4% in extracorporeal membrane oxygenation patients and 7.6% in conventionally managed patients (p = 0.04). Multivariate analysis revealed factors independently associated with intracranial hemorrhage to be duration of ventilation (d) (odds ratio, 1.13 [95% CI, 1.03–1.23]; p = 0.011) and admission fibrinogen (g/L) (odds ratio, 0.73 [0.57–0.91]; p = 0.009); extracorporeal membrane oxygenation was not an independent risk factor (odds ratio, 3.29 [0.96–15.99]; p = 0.088). In patients who received veno-venous extracorporeal membrane oxygenation, there was no significant difference in 6-month survival between patients with and without intracranial hemorrhage (68.3% vs 76.0%; p = 0.350). Good neurologic function was observed in 92%. CONCLUSIONS:We report a higher prevalence of intracranial hemorrhage than has previously been described with high level of neurologically intact survival. Duration of mechanical ventilation and admission fibrinogen, but not exposure to extracorporeal support, are independently associated with intracranial hemorrhage.