The following is a summary of “Prognostic Factors Associated With Intracranial Hemorrhage and Ischemic Stroke During Venovenous Extracorporeal Membrane Oxygenation: A Systematic Review,” published in the December 2024 issue of Critical Care by Thiara et al. 

Venovenous extracorporeal membrane oxygenation (ECMO) was a life-saving intervention for patients with respiratory failure unresponsive to conventional mechanical ventilation, though it was associated with serious complications like intracranial hemorrhage (ICH) and ischemic stroke.  

Researchers conducted a retrospective study to identify prognostic factors associated with ICH and ischemic stroke during venovenous ECMO.  

They searched the literature to identify studies evaluating adults with ICH and ischemic stroke undergoing venovenous ECMO, excluding studies based on design, target population, and outcomes, 1 reviewer manually extracted data, and the risk of bias was estimated using the Quality in Prognostic Studies approach. Prognostic factors linked to ICH and ischemic stroke, identified in 2 or more studies, were assessed by the Grading of Recommendations, Assessment, Development, and Evaluation approach.  

The results showed that 333 studies were screened, with 17 meeting the final inclusion criteria, 17 studies identified predictors of ICH, and 5 studies (moderate certainty) found an increased ICH risk with lower pH before venovenous ECMO. Another 5 studies (moderate certainty) linked higher decreases in Paco₂  pre- to post-venovenous ECMO cannulation with increased ICH risk while 4 studies evaluated predictors of ischemic stroke, but no consistent predictors were identified across 2 or more studies.  

They concluded the abnormalities and changes in blood gas parameters from pre- to post-venovenous ECMO cannulation were likely associated with an increased risk of ICH. Further high-quality studies were crucial to understand the pathophysiology of ICH and ischemic stroke in the population and inform clinical practice to mitigate the risk of life-threatening events. 

Source: journals.lww.com/ccmjournal/fulltext/9900/prognostic_factors_associated_with_intracranial.429.aspx