Stroke in Extracorporeal Membrane Oxygenation Patients: An Analysis from the National Inpatient Sample
Muhammad Sohaib1, Hafiz Maaz2, Muhammad Tayyab Muzaffar Chaychi3, Syed Haris Ahmed4, Haris Kamal5, Muhammad Ahmed6, Muhammad Tayyab Muzaffar Chaychi
1Department of Epidemiology, Rollins Shool of Public Health, Emory University, 2Quaid-e-Azam Medical College, Bahawalpur Pakistan, 3Department of Neurology, University of South Florida Morsani College of Medicine, 4Quaid-e-Azam Medical College, Bahawalpur, Pakistan, 5Memorial Herman Hospital system Woodland TX, 6Medical College of Georgia, Augusta University
Objective:
To analyze the incidence and trends of these events in adult ECMO patients, and to investigate the association between age, gender, race, stroke occurrence, and mortality.
Background:
ECMO is a life-saving intervention for critically ill patients, but carries a risk of ischemic and hemorrhagic events, including stroke.
Design/Methods:
his retrospective study used NIS data (32,311 adult ECMO patients, 2004-2021). Event rates and trends were analyzed. Associations between age and stroke were evaluated using χ2 test and ANOVA. Logistic regression assessed the impact of various factors on mortality.
Results:
total 13.6 % ECMO patient had a stroke, 9.53% of pts had TIA or ischemic , 3.20% hemorrhagic, and 0.88% both. Ischemic events (100-176/yr) peaked in 2021 (235). Hemorrhagic events (21-46/yr) increased in 2020 (171) & 2021 (224). 13.6% had a stroke. Stroke incidence: 5.76% (18-34 yrs), 10.19% (35-49 yrs), 13.75% (50-64 yrs), 19.18% (65+ yrs) (χ2(3)=622.00, p=0.000). Pts with stroke were older (mean 61.69 yrs) vs. those without (mean 54.08 yrs) (F=715.25, p<0.0001). Mortality rates differed across stroke groups (F=156.36, p<0.001): no stroke (21.93%), ischemic (19.29%), hemorrhagic (48.01%), combined (42.29%). Hemorrhagic stroke (OR=2.75, p<0.001) & combined stroke (OR=1.69, p=0.001) increased mortality risk vs. ischemic stroke. Larger hospital size (OR=2.12 & 3.69 for size 2 & 3, p<0.005) & certain races (OR 1.60-1.93, p<0.01) also increased mortality. Age (OR=0.99, p=0.007) & LOS (OR=0.99, p=0.01) slightly reduced mortality.
Conclusions:
This study highlights the risk of ischemic and hemorrhagic events in adult ECMO pts, especially the rise in hemorrhagic events. Stroke type and age is a significant predictor of mortality, with hemorrhagic strokes increasing risk.
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