Meghana Jami, BS
Medical Student
Johns Hopkins School of Medicine, United States
Disclosure information not submitted.
Lavienraj Premraj, BMsc (he/him/his)
Griffith University School of Medicine
Brisbane, QLD, Australia
Disclosure information not submitted.
Eric Etchill, MD, MPH
Surgery resident
The Johns Hopkins Hospital
Baltimore, MD
Disclosure information not submitted.
Katherine Giuliano, MD
Fellow/JHH Assistant Resident
n/a, United States
Disclosure information not submitted.
Errol Bush, MD
Associate Professor
Johns Hopkins School of Medicine, United States
Disclosure information not submitted.
Bo Kim, MD
Assistant Professor
Johns Hopkins Pulmonary and Critical Care Medicine, United States
Disclosure information not submitted.
Stella Seal, MLS
Librarian III
Johns Hopkins School of Medicine, United States
Disclosure information not submitted.
Glenn Whitman, MD
Professor
Johns Hopkins Hospital, United States
Disclosure information not submitted.
Sung-Min Cho, DO, MHS
Assistant Professor
Johns Hopkins Hospital, United States
Disclosure information not submitted.
Title: Neurological Complications in COVID-19 Patients with ECMO Support: A Systematic Review
INTRODUCTION/HYPOTHESIS: Patients with Coronavirus disease 2019 (COVID-19)-related acute respiratory disease (ARDS) increasingly receive extracorporeal membrane oxygenation (ECMO) support. While ECMO has been shown to increase risk of stroke, few studies have examined this association in COVID-19 patients. We conducted a systematic review to characterize neurological events during ECMO support in COVID-19 patients.
Methods: Studies were retrieved from PubMed, Embase, Cochrane, Cochrane COVID-19 Study Register, Web of Science, Scopus, Clinicaltrials.gov, and mdRxiv from inception to November 11, 2020. Inclusion criteria were a) adult population ( >18 years old); b) positive PCR test for SARS-CoV-2 with active COVID-19 disease; c) ECMO therapy due to COVID-19 ARDS; and d) neurological events and outcome described while on ECMO support. We excluded articles when no details of neurologic events were available.
Results: 1,322 patients from 12 case series and retrospective cohort studies were included in our study. The median age was 49.2, and 75% (n=985) of the patients were male. Diabetes mellitus and dyslipidemia were the most common comorbidities (24% and 20%, respectively). Most (95%, n=1,241) patients were on venovenous ECMO with a median P:F ratio at the time of ECMO cannulation of 69.1. The prevalence of intracranial hemorrhage, ischemic stroke, and hypoxic ischemic brain injury was 5.9% (n=78), 1.1% (n=15), and 0.3% (n=4), respectively. The overall mortality of the 1,296 ECMO patients in the 10 studies that reported death was 36% (n=477), and the mortality of the subset of patients who had a neurological event was 92%.
Conclusions: Neurological injury is a concern for COVID-19 patients who receive ECMO. Further research is required to explore how neuromonitoring protocols can inform tailored anticoagulation management and improve survival in COVID-19 patients with ECMO support.