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Neurologic Complications of Extracorporeal Membrane Oxygenation.

Nasr DM, Rabinstein AA - J Clin Neurol (2015)

Bottom Line: When compared to patients without neurologic complications, acute ischemic stroke patients had significantly higher rates of discharge to a long-term facility (12.2% vs. 6.8%, p<0.0001) and a significantly longer mean length of stay (41.6 days vs. 31.9 days, p<0.0001).These outcomes did not differ significantly between seizure patients and patients without neurologic complications.Given the increasing utilization of ECMO and the high costs and poor outcomes associated with neurologic complications, more research is needed to help determine the best way to prevent these sequelae in this patient population.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Mayo Clinic, Rochester, MN, USA. nasr.deena@mayo.edu.

ABSTRACT

Background and purpose: The rate and outcomes of neurologic complications of patients receiving extracorporeal membrane oxygenation (ECMO) are poorly understood. The purpose of this study was to identify these parameters in ECMO patients.

Methods: All patients receiving ECMO were selected from the Nationwide Inpatient Sample between 2001-2011. The rate and outcomes of neurologic complications [acute ischemic stroke, intracranial hemorrhage (ICH), and seizures] among these patients was determined. Discharge status, mortality, length of stay, and hospitalization costs were compared between patients with and without neurologic complications using chi-squared tests for categorical variables and Student's t-test for continuous variables.

Results: In total, 23,951 patients were included in this study, of which 2,604 (10.9%) suffered neurologic complications of seizure (4.1%), stroke (4.1%), or ICH (3.6%). When compared to patients without neurologic complications, acute ischemic stroke patients had significantly higher rates of discharge to a long-term facility (12.2% vs. 6.8%, p<0.0001) and a significantly longer mean length of stay (41.6 days vs. 31.9 days, p<0.0001). ICH patients had significantly higher rates of discharge to a long-term facility (9.5% vs. 6.8%, p=0.007), significantly higher mortality rates (59.7% vs. 50.0%, p<0.0001), and a significantly longer mean length of stay (41.8 days vs. 31.9 days) compared to patients without neurologic complications. These outcomes did not differ significantly between seizure patients and patients without neurologic complications.

Conclusions: Given the increasing utilization of ECMO and the high costs and poor outcomes associated with neurologic complications, more research is needed to help determine the best way to prevent these sequelae in this patient population.

No MeSH data available.


Related in: MedlinePlus

Number of patients treated with extracorporeal membrane oxygenation (ECMO) during theperiod 2001-2011. Graphical representation of ECMO utilization in the United StatesNationwide Inpatient Sample from the period 2001-2011. ECMO utilization increased from1,613 patients in 2001 to 3,597 patients in 2011. Utilization in adults increased from 309patients in 2001 to 2004 patients in 2011; these data for the pediatric population are1,027 and 1,434 patients, respectively.
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Figure 1: Number of patients treated with extracorporeal membrane oxygenation (ECMO) during theperiod 2001-2011. Graphical representation of ECMO utilization in the United StatesNationwide Inpatient Sample from the period 2001-2011. ECMO utilization increased from1,613 patients in 2001 to 3,597 patients in 2011. Utilization in adults increased from 309patients in 2001 to 2004 patients in 2011; these data for the pediatric population are1,027 and 1,434 patients, respectively.

Mentions: In total, 23,951 patients were included in this study. The number of patients receivingECMO increased from 1,613 patients in 2001 to 3597 patients in 2011 (Fig. 1). The number of pediatric patients receiving ECMO increased from1,027 to 1,434 during the same time period, while the number of adult ECMO patientsincreased from 309 to 2004 (Fig. 1). Age data wereavailable for 21,304 patients; these patients were 18.5±56.3 years old, and 7,741patients (36.3%) were younger than 1 month and 8,398 patients (39.4%) were≥18 years old. The most common indication/comorbidity was congenital heart disease(n=11,712, 48.9%) followed by adult respiratory failure(n=11,407, 47.6%) and shock (n=7,369,30.8%). These data are summarized in Table1. The most common indications/comorbidities by age group were congenital heartdisease for patients aged <1 month (86.8%) and aged between 1 month and 1year (71.0%). Respiratory failure was the most common indication in patients aged1-17 years (70.5%), 18-64 years (77.0%), and ≥65 years(66.6%). These data are summarized in Supplementary Table 1 (in the online-only Data Supplement).


Neurologic Complications of Extracorporeal Membrane Oxygenation.

Nasr DM, Rabinstein AA - J Clin Neurol (2015)

Number of patients treated with extracorporeal membrane oxygenation (ECMO) during theperiod 2001-2011. Graphical representation of ECMO utilization in the United StatesNationwide Inpatient Sample from the period 2001-2011. ECMO utilization increased from1,613 patients in 2001 to 3,597 patients in 2011. Utilization in adults increased from 309patients in 2001 to 2004 patients in 2011; these data for the pediatric population are1,027 and 1,434 patients, respectively.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4596114&req=5

Figure 1: Number of patients treated with extracorporeal membrane oxygenation (ECMO) during theperiod 2001-2011. Graphical representation of ECMO utilization in the United StatesNationwide Inpatient Sample from the period 2001-2011. ECMO utilization increased from1,613 patients in 2001 to 3,597 patients in 2011. Utilization in adults increased from 309patients in 2001 to 2004 patients in 2011; these data for the pediatric population are1,027 and 1,434 patients, respectively.
Mentions: In total, 23,951 patients were included in this study. The number of patients receivingECMO increased from 1,613 patients in 2001 to 3597 patients in 2011 (Fig. 1). The number of pediatric patients receiving ECMO increased from1,027 to 1,434 during the same time period, while the number of adult ECMO patientsincreased from 309 to 2004 (Fig. 1). Age data wereavailable for 21,304 patients; these patients were 18.5±56.3 years old, and 7,741patients (36.3%) were younger than 1 month and 8,398 patients (39.4%) were≥18 years old. The most common indication/comorbidity was congenital heart disease(n=11,712, 48.9%) followed by adult respiratory failure(n=11,407, 47.6%) and shock (n=7,369,30.8%). These data are summarized in Table1. The most common indications/comorbidities by age group were congenital heartdisease for patients aged <1 month (86.8%) and aged between 1 month and 1year (71.0%). Respiratory failure was the most common indication in patients aged1-17 years (70.5%), 18-64 years (77.0%), and ≥65 years(66.6%). These data are summarized in Supplementary Table 1 (in the online-only Data Supplement).

Bottom Line: When compared to patients without neurologic complications, acute ischemic stroke patients had significantly higher rates of discharge to a long-term facility (12.2% vs. 6.8%, p<0.0001) and a significantly longer mean length of stay (41.6 days vs. 31.9 days, p<0.0001).These outcomes did not differ significantly between seizure patients and patients without neurologic complications.Given the increasing utilization of ECMO and the high costs and poor outcomes associated with neurologic complications, more research is needed to help determine the best way to prevent these sequelae in this patient population.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Mayo Clinic, Rochester, MN, USA. nasr.deena@mayo.edu.

ABSTRACT

Background and purpose: The rate and outcomes of neurologic complications of patients receiving extracorporeal membrane oxygenation (ECMO) are poorly understood. The purpose of this study was to identify these parameters in ECMO patients.

Methods: All patients receiving ECMO were selected from the Nationwide Inpatient Sample between 2001-2011. The rate and outcomes of neurologic complications [acute ischemic stroke, intracranial hemorrhage (ICH), and seizures] among these patients was determined. Discharge status, mortality, length of stay, and hospitalization costs were compared between patients with and without neurologic complications using chi-squared tests for categorical variables and Student's t-test for continuous variables.

Results: In total, 23,951 patients were included in this study, of which 2,604 (10.9%) suffered neurologic complications of seizure (4.1%), stroke (4.1%), or ICH (3.6%). When compared to patients without neurologic complications, acute ischemic stroke patients had significantly higher rates of discharge to a long-term facility (12.2% vs. 6.8%, p<0.0001) and a significantly longer mean length of stay (41.6 days vs. 31.9 days, p<0.0001). ICH patients had significantly higher rates of discharge to a long-term facility (9.5% vs. 6.8%, p=0.007), significantly higher mortality rates (59.7% vs. 50.0%, p<0.0001), and a significantly longer mean length of stay (41.8 days vs. 31.9 days) compared to patients without neurologic complications. These outcomes did not differ significantly between seizure patients and patients without neurologic complications.

Conclusions: Given the increasing utilization of ECMO and the high costs and poor outcomes associated with neurologic complications, more research is needed to help determine the best way to prevent these sequelae in this patient population.

No MeSH data available.


Related in: MedlinePlus