Later initiation of ECMO is associated with intracranial hemorrhage in COVID-19 patients

Abstract

Abstract The occurrence of severe intracranial hemorrhage under venovenous extracorporeal membrane oxygenation (VV-ECMO) is a diagnostic and therapeutic challenge. The aim of this retrospective study is to determine factors associated with the occurrence of severe intracranial hemorrhage under VV-ECMO in patients with SARS-CoV-2 infection. Among the 43 COVID-19 VV-ECMO patients included (seven women, median age: 55 years), eight patients(19%) presented an intracranial hemorrhage during VV-ECMO treatment, and 10 patients didn’t show any signs of intracranial hemorrhage on brain imaging. Twenty-five patients didn’t have imaging during or after VV-ECMO treatment. Kaplan-Meier analysis showed that the delay from hospital admission to VV-ECMO initiation was longer in patients with intracranial hemorrhage than in patients without intracranial hemorrhage(log-rank test P=0.03). Minute ventilation before cannulation was significantly lower in patients with intracranial hemorrhage compared to patients without intracranial hemorrhage: median(range)= 7.7L/min (3.9–14.0) vs. 12.1L/min(8.3–16.0);P=0.04. Arterial lactate values were higher in patients with intracranial hemorrhage compared to patients without intracranial hemorrhage: median(range)= 3.0mmol/L(1.1–6.6) vs. 1.9mmol/L(1.1–2.8);P=0.03. The occurrence of intracranial hemorrhage was associated with a longer period from hospitalization to VV-ECMO initiation, as well as hypoventilation and higher arterial lactate levels before VV-ECMO treatment.