• Yuanyuan Yu, Iris Lettow, Kevin Roedl, Dominik Jarczak, Hans Pinnschmidt, Hermann Reichenspurner, Alexander M Bernhardt, Gerold Söffker, Benedikt Schrage, Markus Haar, Theresa Weber, Daniel Frings, Stefan Kluge, and Marlene Fischer.
• Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
• J Crit Care. 2024 Dec 1; 84: 154880154880.

PurposeTo assess the association between fluctuations of arterial carbon dioxide early after start of extracorporeal membrane oxygenation (ECMO) with intracranial hemorrhage (ICH) or ischemic stroke (IS).Materials And MethodsThis single-center retrospective study included patients who required ECMO for circulatory or respiratory failure between January 2011 and April 2021 and for whom a cerebral computed tomography (cCT) scan was available. Multivariable logistic regression models were fitted to evaluate the association between the relative change of arterial carbon dioxide (RelΔPaCO2) and ICH, IS or a composite of ICH, IS, and mortality.ResultsIn 618 patients (venovenous ECMO: n = 295; venoarterial ECMO: n = 323) ICH occurred more frequently in patients with respiratory failure (19.0%) compared with patients with circulatory failure (6.8%). Conversely, the incidence of IS was higher in patients with circulatory failure (19.2%) compared with patients with respiratory failure (4.7%). While patients with ECMO for respiratory failure were more likely to have ICH (OR 3.683 [95% CI: 1.855;7.309], p < 0.001), they had a lower odds for IS (OR 0.360 [95%CI: 0.158;0.820], p = 0.015) compared with patients with circulatory failure. There was no significant association between RelΔPaCO2 and ICH or IS.ConclusionsIrrespective of the indication for ECMO, we did not find a significant association between the relative change in PaCO2 early after ECMO initiation and acute brain injury. Aside from early PaCO2 decline at cannulation, future studies should address fluctuations of PaCO2 throughout the course of ECMO support and their effect on acute brain injury.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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