Background
Acute brain injury (ABI) remains common after extracorporeal cardiopulmonary resuscitation
(ECPR). Using a large international multicenter cohort, we investigated the impact
of peri-cannulation arterial oxygen (PaO2) and carbon dioxide (PaCO2) on ABI occurrence.
Methods
We retrospectively analyzed adult (≥18 years old) ECPR patients in the Extracorporeal
Life Support Organization registry from 1/2009 through 12/2020. Composite ABI included
ischemic stroke, intracranial hemorrhage (ICH), seizures, and brain death. The registry
collects 2 blood gas data pre- (6 hours) and post- (24 hours) cannulation. Blood gas
parameters were classified as: hypoxia (<60mm Hg), normoxia (60-119mm Hg), and mild
(120-199mm Hg), moderate (200-299mm Hg), and severe hyperoxia (≥300mm Hg); hypocarbia
(<35mm Hg), normocarbia (35-44mm Hg), mild (45-54mm Hg) and severe hypercarbia (≥55mm
Hg). Missing values were handled using multiple imputation. Multivariable logistic
regression analysis was used to assess the relationship of PaO2 and PaCO2 with ABI.
Results
Of 3,125 patients with ECPR intervention (median age=58, 69% male), 488 (16%) experienced
ABI (7% ischemic stroke; 3% ICH). In multivariable analysis, on-ECMO moderate (aOR=1.42,
95%CI: 1.02-1.97) and severe hyperoxia (aOR=1.59, 95%CI: 1.20-2.10) were associated
with composite ABI. Additionally, severe hyperoxia was associated with ischemic stroke
(aOR=1.63, 95%CI: 1.11-2.40), ICH (aOR=1.92, 95%CI: 1.08-3.40), and in-hospital mortality
(aOR=1.58, 95%CI: 1.21-2.06). Mild hypercarbia pre-ECMO was protective of composite
ABI (aOR=0.61, 95%CI: 0.44-0.84) and ischemic stroke (aOR=0.56, 95%CI: 0.35-0.89).
Conclusions
Early severe hyperoxia (≥300mm Hg) on ECMO was a significant risk factor for ABI and
mortality. Careful consideration should be given in early oxygen delivery in ECPR
patients who are at risk of reperfusion injury.
KEYWORDS
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Published online: November 05, 2022
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