• Akram M Zaaqoq, Matthew J Griffee, Thu-Lan Kelly, Jonathon P Fanning, Silver Heinsar, Jacky Y Suen, Silvia Mariani, Gianluigi Li Bassi, Jeffrey P Jacobs, Nicole White, John F Fraser, Roberto Lorusso, Giles J Peek, Sung-Min Cho, and COVID-19 Critical Care Consortium (COVID Critical).
• Department of Critical Care Medicine, MedStar Washington Hospital Center, Georgetown University, Washington, DC.
• Crit. Care Med. 2023 Aug 1; 51 (8): 104310531043-1053.

ObjectivesEvidence of cerebrovascular complications in COVID-19 requiring venovenous extracorporeal membrane oxygenation (ECMO) is limited. Our study aims to characterize the prevalence and risk factors of stroke secondary to COVID-19 in patients on venovenous ECMO.DesignWe analyzed prospectively collected observational data, using univariable and multivariable survival modeling to identify risk factors for stroke. Cox proportional hazards and Fine-Gray models were used, with death and discharge treated as competing risks.SettingThree hundred eighty institutions in 53 countries in the COVID-19 Critical Care Consortium (COVID Critical) registry.PatientsAdult COVID-19 patients who were supported by venovenous ECMO.InterventionsNone.Measurements And Main ResultsFive hundred ninety-five patients (median age [interquartile range], 51 yr [42-59 yr]; male: 70.8%) had venovenous ECMO support. Forty-three patients (7.2%) suffered strokes, 83.7% of which were hemorrhagic. In multivariable survival analysis, obesity (adjusted hazard ratio [aHR], 2.19; 95% CI, 1.05-4.59) and use of vasopressors before ECMO (aHR, 2.37; 95% CI, 1.08-5.22) were associated with an increased risk of stroke. Forty-eight-hour post-ECMO Pa co2 -pre-ECMO Pa co2 /pre-ECMO Pa co2 (relative ΔPa co2 ) of negative 26% and 48-hour post-ECMO Pa o2 -pre-ECMO Pa o2 /pre-ECMO Pa o2 (relative ΔPa o2 ) of positive 24% at 48 hours of ECMO initiation were observed in stroke patients in comparison to relative ΔPa co2 of negative 17% and relative ΔPa o2 of positive 7% in the nonstroke group. Patients with acute stroke had a 79% in-hospital mortality compared with 45% mortality for stroke-free patients.ConclusionsOur study highlights the association of obesity and pre-ECMO vasopressor use with the development of stroke in COVID-19 patients on venovenous ECMO. Also, the importance of relative decrease in Pa co2 and moderate hyperoxia within 48 hours after ECMO initiation were additional risk factors.Copyright © 2023 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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