Incidence, Outcome, and Predictors of Intracranial Hemorrhage in Adult Patients on Extracorporeal Membrane Oxygenation: A Systematic and Narrative Review
Background: Intracranial hemorrhage (ICH) is a common complication in adults treated with extracorporeal membrane oxygenation (ECMO).Objectives: The aim of this study was to conduct a systematic review of the literature on the incidence, outcome and predictors of ECMO-associated ICH in adult patient...
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| Format: | Article |
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Frontiers Media S.A.
2018-07-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fneur.2018.00548/full |
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| author | Alexander Fletcher-Sandersjöö Alexander Fletcher-Sandersjöö Eric Peter Thelin Eric Peter Thelin Jiri Bartek Jiri Bartek Jiri Bartek Jiri Bartek Mikael Broman Mikael Broman Marko Sallisalmi Adrian Elmi-Terander Bo-Michael Bellander Bo-Michael Bellander |
| author_facet | Alexander Fletcher-Sandersjöö Alexander Fletcher-Sandersjöö Eric Peter Thelin Eric Peter Thelin Jiri Bartek Jiri Bartek Jiri Bartek Jiri Bartek Mikael Broman Mikael Broman Marko Sallisalmi Adrian Elmi-Terander Bo-Michael Bellander Bo-Michael Bellander |
| author_sort | Alexander Fletcher-Sandersjöö |
| collection | DOAJ |
| description | Background: Intracranial hemorrhage (ICH) is a common complication in adults treated with extracorporeal membrane oxygenation (ECMO).Objectives: The aim of this study was to conduct a systematic review of the literature on the incidence, outcome and predictors of ECMO-associated ICH in adult patients, supplemented by a narrative review of its pathophysiology, management and future perspectives.Methods: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews and www.clinicaltrials.gov were systematically searched. Studies that reported incidence, outcome or predictors of ECMO-associated ICH in adults (≥18 years) were eligible for inclusion.Results: Twenty five articles were included in the systematic review. The incidence of ECMO-associated ICH varied between 1.8 and 21 %. Mortality rates in ICH-cohorts varied between 32 and 100 %, with a relative risk of mortality of 1.27–4.43 compared to non-ICH cohorts. An increased risk of ICH was associated with ECMO-duration, antithrombotic therapy, altered intrinsic coagulation, renal failure, need of blood products, rapid hypercapnia at ECMO initiation, and even pre-ECMO morbidity.Conclusions: ICH is a common complication in adults treated with ECMO and associated with increased mortality. Treating an ICH during ECMO represents a balance between pro- and anticoagulatory demands. Neurosurgical treatment is associated with severe morbidity, but has been successful in selected cases. Future studies should aim at investigating the validity and feasibility of non-invasive monitoring in early detection of ECMO-associated ICH. |
| first_indexed | 2024-12-12T20:44:46Z |
| format | Article |
| id | doaj.art-447e1fffe6a34ff4b2eb288a2d55bfff |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-12-12T20:44:46Z |
| publishDate | 2018-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-447e1fffe6a34ff4b2eb288a2d55bfff2022-12-22T00:12:37ZengFrontiers Media S.A.Frontiers in Neurology1664-22952018-07-01910.3389/fneur.2018.00548386019Incidence, Outcome, and Predictors of Intracranial Hemorrhage in Adult Patients on Extracorporeal Membrane Oxygenation: A Systematic and Narrative ReviewAlexander Fletcher-Sandersjöö0Alexander Fletcher-Sandersjöö1Eric Peter Thelin2Eric Peter Thelin3Jiri Bartek4Jiri Bartek5Jiri Bartek6Jiri Bartek7Mikael Broman8Mikael Broman9Marko Sallisalmi10Adrian Elmi-Terander11Bo-Michael Bellander12Bo-Michael Bellander13Department of Neurosurgery, Karolinska University Hospital, Stockholm, SwedenDepartment of Clinical Neuroscience, Karolinska Institutet, Stockholm, SwedenDepartment of Clinical Neuroscience, Karolinska Institutet, Stockholm, SwedenDivision of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United KingdomDepartment of Neurosurgery, Karolinska University Hospital, Stockholm, SwedenDepartment of Clinical Neuroscience, Karolinska Institutet, Stockholm, SwedenDepartment of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, DenmarkDepartment of Medicine, Karolinska Institutet, Stockholm, SwedenECMO Center Karolinska, Karolinska University Hospital, Stockholm, SwedenDepartment of Physiology and Pharmacology, Karolinska Institutet, Stockholm, SwedenECMO Center Karolinska, Karolinska University Hospital, Stockholm, SwedenDepartment of Neurosurgery, Karolinska University Hospital, Stockholm, SwedenDepartment of Neurosurgery, Karolinska University Hospital, Stockholm, SwedenDepartment of Clinical Neuroscience, Karolinska Institutet, Stockholm, SwedenBackground: Intracranial hemorrhage (ICH) is a common complication in adults treated with extracorporeal membrane oxygenation (ECMO).Objectives: The aim of this study was to conduct a systematic review of the literature on the incidence, outcome and predictors of ECMO-associated ICH in adult patients, supplemented by a narrative review of its pathophysiology, management and future perspectives.Methods: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews and www.clinicaltrials.gov were systematically searched. Studies that reported incidence, outcome or predictors of ECMO-associated ICH in adults (≥18 years) were eligible for inclusion.Results: Twenty five articles were included in the systematic review. The incidence of ECMO-associated ICH varied between 1.8 and 21 %. Mortality rates in ICH-cohorts varied between 32 and 100 %, with a relative risk of mortality of 1.27–4.43 compared to non-ICH cohorts. An increased risk of ICH was associated with ECMO-duration, antithrombotic therapy, altered intrinsic coagulation, renal failure, need of blood products, rapid hypercapnia at ECMO initiation, and even pre-ECMO morbidity.Conclusions: ICH is a common complication in adults treated with ECMO and associated with increased mortality. Treating an ICH during ECMO represents a balance between pro- and anticoagulatory demands. Neurosurgical treatment is associated with severe morbidity, but has been successful in selected cases. Future studies should aim at investigating the validity and feasibility of non-invasive monitoring in early detection of ECMO-associated ICH.https://www.frontiersin.org/article/10.3389/fneur.2018.00548/fullintracranial hemorrhageintracerebral hemorrhagebrain injuryneurological injuryextracorporeal membrane oxygenationextracorporeal life support |
| spellingShingle | Alexander Fletcher-Sandersjöö Alexander Fletcher-Sandersjöö Eric Peter Thelin Eric Peter Thelin Jiri Bartek Jiri Bartek Jiri Bartek Jiri Bartek Mikael Broman Mikael Broman Marko Sallisalmi Adrian Elmi-Terander Bo-Michael Bellander Bo-Michael Bellander Incidence, Outcome, and Predictors of Intracranial Hemorrhage in Adult Patients on Extracorporeal Membrane Oxygenation: A Systematic and Narrative Review Frontiers in Neurology intracranial hemorrhage intracerebral hemorrhage brain injury neurological injury extracorporeal membrane oxygenation extracorporeal life support |
| title | Incidence, Outcome, and Predictors of Intracranial Hemorrhage in Adult Patients on Extracorporeal Membrane Oxygenation: A Systematic and Narrative Review |
| title_full | Incidence, Outcome, and Predictors of Intracranial Hemorrhage in Adult Patients on Extracorporeal Membrane Oxygenation: A Systematic and Narrative Review |
| title_fullStr | Incidence, Outcome, and Predictors of Intracranial Hemorrhage in Adult Patients on Extracorporeal Membrane Oxygenation: A Systematic and Narrative Review |
| title_full_unstemmed | Incidence, Outcome, and Predictors of Intracranial Hemorrhage in Adult Patients on Extracorporeal Membrane Oxygenation: A Systematic and Narrative Review |
| title_short | Incidence, Outcome, and Predictors of Intracranial Hemorrhage in Adult Patients on Extracorporeal Membrane Oxygenation: A Systematic and Narrative Review |
| title_sort | incidence outcome and predictors of intracranial hemorrhage in adult patients on extracorporeal membrane oxygenation a systematic and narrative review |
| topic | intracranial hemorrhage intracerebral hemorrhage brain injury neurological injury extracorporeal membrane oxygenation extracorporeal life support |
| url | https://www.frontiersin.org/article/10.3389/fneur.2018.00548/full |
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