Stroke Patterns and Cannulation Strategy during Veno-Arterial
Extracorporeal Membrane Support
Abstract
Objectives Stroke has potentially devastating consequences for patients
receiving veno-arterial extracorporeal membrane support (VA-ECMO).
Arterial cannulation sites for VA-ECMO include the ascending aorta,
axillary artery, and femoral artery. However, the influence of
cannulation site on stroke risk has not been well described. The purpose
of this study was to investigate the association between occurrence and
patterns of stroke with ECMO arterial cannulation sites. Methods We
retrospectively reviewed 414 consecutive patients who received VA-ECMO
support for cardiogenic shock between March 2007 and May 2018. Patients
were categorized by cannulation strategy. The rates, subtype and
location of strokes as assessed by neuroimaging during and after VA-ECMO
support were analyzed. Results Median age was 61 years (IQR 50-69); 67%
were men. 77 patients were cannulated via the ascending aorta (17%), 31
via the axillary artery (7%), and 306 (69%) via the femoral artery. In
total, 26 patients (6.3%) developed 30 stroke lesions at a median of
6.0 (IQR 3.1-8.7) days after ECMO cannulation. Ischemic stroke was the
most common subtype (64%), followed by hemorrhagic transformation
(20%) and hemorrhagic stroke (16%). Location by CT was right
hemispheric in 38%, left hemispheric in 24%, bilateral in 21%, and
vertebrobasilar in 17%. The incidence of stroke was similar across
cannulation strategies: aorta (n=5, 6.5%), axillary artery (n=2,
6.5%), and femoral artery (n=19, 6.2%), (p=0.99). Conclusions
Incidence of stroke does not appear to differ among patients cannulated
via the ascending aorta, axillary artery, or femoral artery. Ischemic
stroke was the most common subtype of stroke.