Photo Credit: YakobchukOlena

The following is a summary of “Association of early changes in arterial carbon dioxide with acute brain injury in adult patients with extracorporeal membrane oxygenation: A ten-year retrospective study in a German tertiary care hospital,” published in the December 2024 issue of Critical Care by Yu et al. 

Researchers conducted a retrospective study to examine the link between early arterial carbon dioxide fluctuations after extracorporeal membrane oxygenation (ECMO) initiation and the occurrence of intracranial hemorrhage (ICH) or ischemic stroke (IS). 

They assessed patients who required ECMO for circulatory or respiratory failure between January 2011 and April 2021, with a cerebral computed tomography (cCT) scan available. Multivariable logistic regression models were applied to examine the association between the relative change in arterial carbon dioxide (RelΔPaCO₂) and ICH, IS, or a composite of ICH, IS, and mortality. 

The results showed that in 618 patients (venovenous ECMO: n = 295; venoarterial ECMO: n = 323), ICH was more common in patients with respiratory failure (19.0%) than in those with circulatory failure (6.8%). In contrast, IS was more frequent in patients with circulatory failure (19.2%) than in those with respiratory failure (4.7%). Patients on ECMO for respiratory failure had higher odds of ICH (OR 3.683 [95% CI: 1.855; 7.309], P < 0.001) and lower odds of IS (OR 0.360 [95% CI: 0.158; 0.820], P = 0.015) compared to those with circulatory failure. No significant association was found between relative change in arterial carbon dioxide (RelΔPaCO₂) and ICH or IS. 

Investigators concluded early changes in PaCO₂ after ECMO initiation were not significantly associated with acute brain injury, suggesting that future research should explore the impact of PaCO₂ fluctuations throughout the ECMO course on this outcome. 

Source: sciencedirect.com/science/article/pii/S0883944124003678#ab0005