Association between cerebral microbleeds and neurological outcomes in Extracorporeal Membrane Oxygenation survivors

Abstract

Abstract Background Changes in blood coagulation factors are associated with neurological deficits in extracorporeal membrane oxygenation (ECMO) survivors. These blood coagulation factors have a diverse impact on the brain and are associated with cerebral microbleeds (CMBs). However, how CMBs mediate the association of blood coagulation factors with neurological deficits in ECMO survivors is not well understood. Here, we aimed to determine how CMBs mediate the association of blood coagulation factors with neurological deficits in ECMO survivors. Methods In this single-center study, blood coagulation profiles during ECMO support including activated clotting time (ACT), prothrombin time (PT), activated partial thromboplastin time (aPTT), international normalized ratio (INR), D-Dimer, and fibrinogen levels were documented. Additionally, lowest hemoglobin levels, highest lactate levels, highest sequential organ failure assessment (SOFA) scores, and Glasgow Coma Scale (GCS) scores within 14 days were recorded. After ECMO discontinuation, stable patients underwent cerebral imaging to assess cerebral microbleeds (CMBs) burden. 90 days post-ECMO, a neurological examination via a modified Rankin scale (mRS) was performed. Results There were 138 ECMO survivors mean age = 53.44 ± 8.96 years; 47.10% males; of the 138 patients, 78 (56.52%) underwent VA ECMO support while 60 (43.48%) underwent VV ECMO. CMB burden significantly correlated (P < 0.05) with most blood coagulation factors. In patients with VV ECMO support, CMB count significantly correlated with ACT (P = 0.003) and SOFA (P = 0.002); in patients with VA ECMO support, CMB count correlated with aPTT (P = 0.044) and PLT (P = 0.013). We showed that lactate had a direct effect on mRS after ECMO support (all P < 0.05). We also showed that the effect of ACT and SOFA on mRS scores was mediated by CMB burden (all P < 0.001). Conclusion CMB burden accounts for the effect of ACT and SOFA on neurological deficits in ECMO survivors.