Table 3.
Comparison Between Patients on ECMO With and Without Neurologic Complications
| All patients (N = 16) | No Neurologic Event (n = 12) | Neurologic Event (n = 4) | p Value* | |
|---|---|---|---|---|
| Demographic/past medical history | ||||
| Age, y, median (IQR) | 51 (38-57) | 47 (36-54) | 55.5 (50-59) | 0.129 |
| Sex, male, n (%) | 13 (81) | 11 (92) | 2 (50) | 0.136 |
| Race, n (%) | 0.118 | |||
| African American | 5 (31) | 2 (17) | 3 (75) | |
| Hispanic | 10 (63) | 9 (75) | 1 (25) | |
| BMI, kg/m2, median (IQR) | 31.9 (29.4-35.5) | 32.4 (30.5-35.5) | 29.4 (29.1-34.8) | 0.363 |
| Smoker, n (%) | 1 (6) | 0 (0) | 1 (25) | 0.250 |
| Hypertension, n (%) | 7 (44) | 5 (42) | 2 (50) | 1.000 |
| Diabetes mellitus, n (%) | 6 (38) | 4 (33) | 2 (50) | 0.604 |
| Hyperlipidemia, n (%) | 4 (25) | 2 (17) | 2 (50) | 0.245 |
| Coronary artery disease, n (%) | 1 (6) | 0 (0) | 1 (25) | 0.250 |
| Medications | ||||
| Neuromuscular blockade, n (%) | 16 (100) | 12 (100) | 4 (100) | 1.000 |
| Inhaled nitric oxide, n (%) | 14 (88) | 10 (83) | 4 (100) | 1.000 |
| Vasopressors, n (%) | 12 (75) | 8 (67) | 4 (100) | 0.516 |
| Hydroxychloroquine, n (%) | 2 (13) | 1 (8) | 1 (25) | 0.450 |
| Remdesivir, n (%) | 5 (31) | 5 (42) | 0 (0) | 0.245 |
| IL6 inhibitor, n (%) | 10 (63) | 9 (75) | 1 (25) | 0.118 |
| Steroids, n (%) | 4 (25) | 4 (33) | 0 (0) | 0.516 |
| Convalescent plasma, n (%) | 5 (31) | 4 (33) | 1 (25) | 1.000 |
| Ventilation | ||||
| Proned, n (%) | 16 (100) | 12 (100) | 4 (100) | 1.000 |
| Airway pressure release ventilation, n (%) | 9 (56) | 7 (58) | 2 (50) | 1.000 |
| Mechanical ventilation, n (%) | 16 (100) | 12 (100) | 4 (100) | 1.000 |
| P:F ratio at time of cannulation, median (IQR) | 60.5 (53.5-64) | 60.5 (51-64) | 60.5 (58.5-64.5) | 0.627 |
| Pre-ECMO ventilation, median (IQR) | 6.5 (4.5-7) | 7 (4.5-8) | 5.5 (4.5-6.5) | 0.387 |
| Pre-tracheostomy ventilation, median (IQR) | 14 (13-20) | 14 (12-20) | 15.5 (14-19) | 0.509 |
| Mechanical ventilation support time, d, median (IQR) | 40 (25-51.5) | 41 (20.5-60.5) | 38.5 (33-42.5) | 0.808 |
| ECMO Variables | ||||
| Support time, day, median (IQR) | 27 (15-33) | 24 (13-41) | 29 (25-30) | 0.626 |
| Cannulation site, RIJ, n (%) | 12 (75) | 9 (75) | 3 (75) | 1.000 |
| Speed, rpm, median (IQR) | 3855 (3508-3943) | 3883 (3450-3993) | 3830 (3658-3873) | 0.716 |
| Flow, L/min, median (IQR) | 5 (4.7-5.9) | 5 (4.4-5.7) | 5.6 (5-6.4) | 0.180 |
| Sweep, L/min, median (IQR) | 5.3 (4-7.5) | 5.3 (4.3-7) | 5.5 (3.5-7.5) | 0.712 |
| AC, n (%) | 14 (88) | 11 (92) | 3 (75) | 0.450 |
| Adverse events and complications, n (%) | ||||
| Acute kidney injury | 7 (44) | 5 (42) | 2 (50) | 1.000 |
| Bleeding event | 13 (81) | 9 (75) | 4 (100) | 0.529 |
| Thrombotic event | 6 (38) | 4 (33) | 2 (50) | 0.604 |
| Pneumonia | 12 (75) | 9 (75) | 3 (75) | 1.000 |
| Sepsis | 4 (25) | 3 (25) | 1 (25) | 1.000 |
| Right ventricular dysfunction | 5 (31) | 4 (33) | 1 (25) | 1.000 |
| Outcomes | ||||
| Hospitalization time, d, median (IQR) | 51 (36-66) | 41 (24-77) | 55.5 (43.5-69) | 0.695 |
| Tracheostomy on ECMO, n (%) | 14 (88) | 10 (83) | 4 (100) | 0.550 |
| Death within 30 d of hospital admission, n (%) | 3 (19) | 2 (17) | 1 (25) | 0.673 |
| Laboratory values, median (IQR)† | ||||
| WBC, K/cu mm | 13.2 (9.0-17.8) | 13.2 (9.5-17) | 13.7 (9.0-19.3) | 0.904 |
| Hemoglobin, g/dL | 11.2 (9.2-11.9) | 11.4 (9.3-12.6) | 9.0 (7.6-10.7) | 0.129 |
| Hematocrit, % | 33.8 (29.8-38.9) | 35.5 (31.3-39.3) | 28.9 (24.9-34.2) | 0.069 |
| Platelets, K/cu mm | 281 (174-332) | 297 (239-341) | 132 (108-163) | 0.005 |
| Creatinine, mg/dL | 1.0 (0.8-1.6) | 1.0 (0.7-1.5) | 1.5 (1.2-2.9) | 0.160 |
| Lactate, mmol/L | 2.2 (1.4-3) | 1.8 (1.3-2.9) | 3.2 (2-4.2) | 0.129 |
| AST, U/L | 60 (45-78) | 54 (39-73) | 81 (67-104) | 0.052 |
| ALT, U/L | 43 (33-57) | 41 (33-61) | 44 (35-50) | 1.000 |
| Bilirubin (total), mg/dL | 0.6 (0.4-1.3) | 0.5 (0.4-1.4) | 0.9 (0.5-1.3) | 0.583 |
| IL-6, pg/mL | 290 (167-710) | 290 (167-697) | 795 (231-1,359) | 0.346 |
| LDH, U/L | 558 (453-668) | 515 (428-616) | 697 (560-836) | 0.115 |
| Ferritin, ng/mL | 1099 (785-1,906) | 996 (608-1,906) | 1674 (1,104-3,885) | 0.396 |
| CRP, mg/dL | 17.2 (8.2-35.3) | 14.3 (7-35.3) | 26.8 (14.5-34.6) | 0.467 |
| D-dimer, mg/L | 18 (4-30) | 7 (3-20) | 30 (27-30) | 0.031 |
| Fibrinogen, mg/dL | 469 (322-717) | 551 (396-675) | 496 (165-768) | 1.000 |
| INR | 1.1 (1-1.2) | 1.1 (1-1.2) | 1.25 (1.1-1.4) | 0.342 |
| PT, s | 11.7 (11-13) | 11.7 (10.8-12.6) | 13.1 (11.2-14.9) | 0.280 |
| aPTT, s | 48.9 (37.7-57.5) | 42.8 (36.6-57.5) | 51.1 (46.7-77.1) | 0.240 |
| pH | 7.39 (7.37-7.44) | 7.39 (7.37-7.44) | 7.37 (7.36-7.42) | 0.463 |
| PaCO2, mmHg | 47 (38-50) | 48 (45-52) | 38 (35-43) | 0.060 |
| PaO2, mmHg | 70 (67-77) | 70 (68-76) | 71 (64-91) | 0.952 |
| ΔPaCO2, mmHg | 36 (30-43) | 39 (30-43) | 33 (27-48) | 0.557 |
| ΔPaO2, mmHg | 7 (−18 to 13) | 8 (−9 to 13) | −5 (−30 to 9) | 0.228 |
| Severity of illness, median (IQR) | ||||
| RESP score | 1 (0-3) | 1.5 (0.8-3) | 0.5 (−0.5 to 1.3) | 0.243 |
| SOFA score | 8 (6.5-9.5) | 7 (6-8.5) | 9.5 (9-10.5) | 0.027 |
| Apache II score | 16 (11-20) | 13 (10-20) | 17 (16-23) | 0.179 |
Abbreviations: AC, assist-control; ALT, alanine transferase; aPTT, activated partial thromboplastin time; AST, aspartate transferase; BMI, body mass index; CRP, C-reactive protein; ECMO, extracorporeal membrane oxygenation; IL-6, interleukin 6; INR, international normalized ratio; IQR, interquartile range; LDH, lactate dehydrogenase; P:F, pressure of arterial oxygen to fraction of inspired oxygen; PT, prothrombin time; RESP, Respiratory ECMO Survival Predication; RIJ, right internal jugular; SOFA, Sequential Organ Failure Assessment; WBC, white blood cells.
⁎
Mann-Whitney U and Fisher's exact tests, as appropriate.
†
Values measured on ECMO day 1 closest to time of ECMO cannulation.