Neurologic Complications During Venoarterial Extracorporeal Membrane Oxygenation and Their Implications for 6-Month Patient-Centered Outcomes

Objectives: – Venoarterial extracorporeal membrane oxygenation (ECMO) is associated with neurologic complications but their impact on long-term outcomes are poorly understood. Our objective was to assess the association of neurologic complications with death and new disability at 6 months. 

Design: – Prospective, multicenter, observational study. 

Setting: – Thirty ECMO centers in Australia and New Zealand between February 2019 and December 2022. 

Subjects: – seven hundred four adult patients admitted to the ICU on venoarterial ECMO other than for extracorporeal cardiopulmonary resuscitation. 

Interventions: – None. 

Measurement and Main Results: – Patients were divided according to whether they experienced neurologic complications. Neurologic complications include diffuse cerebral ischemia, stroke, cerebral hemorrhage, and brain death. The primary outcome was a composite of death or new disability at 6 months. Secondary outcomes included disability measured by the World Health Organization Disability Assessment Schedule and quality of life measured with EuroQoL 5D five levels. The median age of patients was 54.5 years (42–64 yr) and 259 (36.8%) were female. The primary outcome was available for 613 of 706 patients (86.2%). Of these, 425 patients (69.3%) had either died or had new disability at 6 months. Neurologic events occurred in 85 patients (12%). Patients who experienced neurologic complications were at increased risk of death or new disability (risk difference [RD], 17.28% [6.44–25.92%]). This was primarily due to an increased risk of mortality RD, 23.75 (12.06–34.75) rather than new disability (RD, –11.90% [–30.58% to 13.56%]). These findings were consistent across types of complications and after adjustment for confounders. Patients with neurologic complications more commonly had ECMO discontinued due to a perceived poor prognosis (odds ratio, 2.7; 95% CI, 1.35–24.7). 

Conclusions: – Neurologic complications during ECMO increased the risk of death and disability at 6 months, primarily driven by increased death at 6 months. Prevention of these complications and development of better prognostic tools for functional outcomes should be prioritized.