Abstract Details

Title A Meta-Analysis on the Neurovascular Complications Of Extracorporeal Membrane Oxygenation In Critically Ill COVID-19 Patients

Topic Neuro Trauma and Critical Care

Presentation(s) S4 - Neurocritical Care (1:36 PM-1:48 PM)

Poster/Presentation
Number 004

Background ECMO is a high-stakes intervention for patients with acute respiratory failure from severe COVID-19 infections. Introduction of extracorporeal circuit, COVID-19 associated endothelial injury and anticoagulation can predispose these patients to neurovascular complications, but the incidence of these adverse events in COVID-19 patients remains unknown.

Objective

To determine the incidence and type of neurovascular complications in adult COVID-19 patients requiring veno-venous extracorporeal membrane oxygenation (VV-ECMO).

Design/Methods

We performed a systematic review and meta-analysis using MEDLINE, Embase, PsycINFO, and Cochrane databases to identify studies that reported neurological complications in adult COVID-19 patients receiving ECMO for respiratory failure. Among 840 identified studies, 28 studies (n = 3147) were included in the systematic review. Studies that had ≥95% of patients on VV-ECMO were pooled for meta-analyses.

Results The incidence of intracranial hemorrhages was 11% [95% CI, 8–15%], and the incidence of ischemic strokes was 2% [9%% CI, 1–3%] in patients with COVID-19 requiring VV-ECMO. Intraparenchymal and subarachnoid hemorrhages accounted for 73% and 8% of all intracranial hemorrhages, respectively. Higher anticoagulation targets did not influence the incidence of intracranial hemorrhages (p = 0.22). One study reported the occurrence of cerebral venous sinus thrombosis.

Conclusions Patients with COVID-19 requiring ECMO have a higher incidence of intracranial hemorrhage compared to historical data in non-COVID-19 patients (11% vs. 8%), while the incidence of ischemic stroke is similar (2%) in both cohorts. Intraparenchymal hemorrhage occurred most frequently. Despite earlier observations of higher thrombotic rates in COVID-19 patients, cerebral venous sinus thrombosis was rarely reported in COVID-19 patients requiring ECMO. Healthcare providers should be aware of these increased risks and maintain a high index of suspicion for intracranial hemorrhage in this patient population.

Authors/Disclosures
Meng Fei Li, MD (London Health Sciences Centre) PRESENTER	Dr. Li has nothing to disclose.
	No disclosure on file
Yu Fei Ma, MD (Kingston Health Sciences Center)	Ms. Ma has nothing to disclose.
Carol Li, Undergrad	Ms. Li has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
Teneille Gofton, MD (London Health Sciences Centre)	The institution of Dr. Gofton has received research support from Government of Canada. The institution of Dr. Gofton has received research support from Canadian Institutes of Health Research. The institution of Dr. Gofton has received research support from Academic Medical Organisation of Southwestern Ontario. Dr. Gofton has a non-compensated relationship as a Medical Advisory Board Member with NORSE Institute that is relevant to AAN interests or activities.
	No disclosure on file
	No disclosure on file