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Eur J Cardiothorac Surg 1999;15:508-514
© 1999 Elsevier Science NL
a Department of Thoracic and Cardiovascular Surgery, F 25 Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
b Transplant Center, Cleveland Clinic Foundation, Cleveland, OH, USA
Received 20 September 1998; received in revised form 18 January 1999; accepted 27 January 1999.
Corresponding author. Tel.: +1-216-445-7052; fax: +1-216-444-0777; e-mail: smedirn@cesmtp.ccf.org
Objective. Intracranial hemorrhage is a recognized complication in neonates and infants on extracorporeal membrane oxygenator support and various risk factors associated with this have been defined. The prevalence and risk factors associated with intracranial hemorrhage in adults on extracorporeal membrane oxygenator support are unknown and this study was performed to define these factors. Methods. A retrospective study of adults supported with extracorporeal membrane oxygenators at a single institution between January 1992 and December 1996 was performed. Age, gender, weight, body surface area, renal function, anticoagulation, coagulation variables, blood flow, arterial pressure, arterial cannulation sites, duration of support, extracranial bleeding, native cardiac function and presence of intracranial microemboli were analyzed to determine the risk factors for intracranial hemorrhage. Results. Fourteen out of 74 adults on extracorporeal membrane oxygenator support had intracranial hemorrhage (18.9%). An increased risk of intracranial hemorrhage showed a positive correlation with female gender (P=0.02, odds ratio 6.5), use of heparin (P=0.05, odds ratio 8.5), creatinine greater than 2.6 mg/dl (P=0.009, odds ratio 6.5), need for dialysis (P=0.03, odds ratio 4.3) and thrombocytopenia (P=0.007, odds ratio 18.3). Diminishing renal function and the need for dialysis were associated with increasing duration of support. Multivariable logistic regression showed female gender and thrombocytopenia, especially with platelet counts less than 50 000 cells/mm3 to be the most important predictors of intracranial hemorrhage. Intracranial hemorrhage was associated with a mortality of 92.3% compared with a mortality of 61% in those without intracranial hemorrhage (P=0.027). Conclusion. Intracranial hemorrhage is a significant complication in adults on extracorporeal membrane oxygenator support. Judicious management of anticoagulation, prevention of renal failure and aggressive correction of thrombocytopenia may help to lower the risk of intracranial hemorrhage in adults on extracorporeal membrane oxygenator support.
Key Words: Intracranial hemorrhage • Adult extracorporeal membrane oxygenation • Support
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