Abstract：
OBJECTIVE: To assess the association between fluctuations of arterial carbon dioxide early after start of extracorporeal membrane oxygenation (ECMO) with intracranial hemorrhage (ICH) or ischemic stroke (IS).
METHODS: This single-center retrospective study included patients who required ECMO for circulatory or respiratory failure between January 2011 and April 2021 and for whom a cerebral computed tomography (cCT) scan was available. Multivariable logistic regression models were fitted to evaluate the association between the relative change of arterial carbon dioxide (RelΔPaCO2) and ICH, IS or a composite of ICH, IS, and mortality.
RESULTS: In 618 patients (venovenous ECMO: n = 295; venoarterial ECMO: n = 323) ICH occurred more frequently in patients with respiratory failure (19.0%) compared with patients with circulatory failure (6.8%). Conversely, the incidence of IS was higher in patients with circulatory failure (19.2%) compared with patients with respiratory failure (4.7%). While patients with ECMO for respiratory failure were more likely to have ICH (OR 3.683 [95% CI: 1.855;7.309], p < 0.001), they had a lower odds for IS (OR 0.360 [95%CI: 0.158;0.820], p = 0.015) compared with patients with circulatory failure. There was no significant association between RelΔPaCO2 and ICH or IS.
CONCLUSIONS: Irrespective of the indication for ECMO, we did not find a significant association between the relative change in PaCO2 early after ECMO initiation and acute brain injury. Aside from early PaCO2 decline at cannulation, future studies should address fluctuations of PaCO2 throughout the course of ECMO support and their effect on acute brain injury.
METHODS: This single-center retrospective study included patients who required ECMO for circulatory or respiratory failure between January 2011 and April 2021 and for whom a cerebral computed tomography (cCT) scan was available. Multivariable logistic regression models were fitted to evaluate the association between the relative change of arterial carbon dioxide (RelΔPaCO2) and ICH, IS or a composite of ICH, IS, and mortality.
RESULTS: In 618 patients (venovenous ECMO: n = 295; venoarterial ECMO: n = 323) ICH occurred more frequently in patients with respiratory failure (19.0%) compared with patients with circulatory failure (6.8%). Conversely, the incidence of IS was higher in patients with circulatory failure (19.2%) compared with patients with respiratory failure (4.7%). While patients with ECMO for respiratory failure were more likely to have ICH (OR 3.683 [95% CI: 1.855;7.309], p < 0.001), they had a lower odds for IS (OR 0.360 [95%CI: 0.158;0.820], p = 0.015) compared with patients with circulatory failure. There was no significant association between RelΔPaCO2 and ICH or IS.
CONCLUSIONS: Irrespective of the indication for ECMO, we did not find a significant association between the relative change in PaCO2 early after ECMO initiation and acute brain injury. Aside from early PaCO2 decline at cannulation, future studies should address fluctuations of PaCO2 throughout the course of ECMO support and their effect on acute brain injury.
摘要：
目的：评估体外膜氧合（ECMO）开始后早期动脉二氧化碳波动与颅内出血（ICH）或缺血性卒中（IS）之间的关系。
方法：这项单中心回顾性研究纳入了2011年1月至2021年4月因循环或呼吸衰竭需要ECMO的患者，这些患者可以进行脑计算机断层扫描（cCT）扫描。多变量logistic回归模型被拟合以评估动脉二氧化碳(RelaPaCO2)的相对变化与ICH之间的关联。是或ICH的复合物，IS,和死亡率。
结果：在618例患者（静脉内ECMO：n=295；静脉动脉内ECMO：n=323）中，呼吸衰竭患者（19.0％）的ICH发生率高于循环衰竭患者（6.8％）。相反，循环衰竭患者的IS发生率(19.2%)高于呼吸衰竭患者(4.7%).而因呼吸衰竭而患有ECMO的患者更有可能患有ICH（OR3.683[95％CI：1.855;7.309]，p<0.001)，他们的IS赔率较低(或0.360[95CI：0.158；0.820]，p=0.015）与循环衰竭患者相比。RelΔPaCO2与ICH或IS之间没有显着关联。
结论：不考虑ECMO的适应症，我们未发现ECMO启动后早期PaCO2的相对变化与急性脑损伤之间存在显著关联.除了插管时PaCO2早期下降，未来的研究应解决整个ECMO支持过程中PaCO2的波动及其对急性脑损伤的影响.
方法：这项单中心回顾性研究纳入了2011年1月至2021年4月因循环或呼吸衰竭需要ECMO的患者，这些患者可以进行脑计算机断层扫描（cCT）扫描。多变量logistic回归模型被拟合以评估动脉二氧化碳(RelaPaCO2)的相对变化与ICH之间的关联。是或ICH的复合物，IS,和死亡率。
结果：在618例患者（静脉内ECMO：n=295；静脉动脉内ECMO：n=323）中，呼吸衰竭患者（19.0％）的ICH发生率高于循环衰竭患者（6.8％）。相反，循环衰竭患者的IS发生率(19.2%)高于呼吸衰竭患者(4.7%).而因呼吸衰竭而患有ECMO的患者更有可能患有ICH（OR3.683[95％CI：1.855;7.309]，p<0.001)，他们的IS赔率较低(或0.360[95CI：0.158；0.820]，p=0.015）与循环衰竭患者相比。RelΔPaCO2与ICH或IS之间没有显着关联。
结论：不考虑ECMO的适应症，我们未发现ECMO启动后早期PaCO2的相对变化与急性脑损伤之间存在显著关联.除了插管时PaCO2早期下降，未来的研究应解决整个ECMO支持过程中PaCO2的波动及其对急性脑损伤的影响.
