• Cheng-Yuan Feng, Anna Kolchinski, Shrey Kapoor, Shivalika Khanduja, Jaeho Hwang, Jose I Suarez, Romergryko G Geocadin, Bo Soo Kim, Glenn Whitman, Sung-Min Cho, and HERALD Investigators.
• Division of Neurosciences Critical Care, Departments of Neurology and Neurosurgery, and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Critical Care Medicine and TriHealth Neuroscience Institute, Cincinnati, OH.
• J. Cardiothorac. Vasc. Anesth. 2024 Nov 1; 38 (11): 269327012693-2701.

ObjectivesTo investigate prevalence, risk factors, and in-hospital outcomes of comatose extracorporeal membrane oxygenation (ECMO) patients.DesignRetrospective observational.SettingTertiary academic hospital.ParticipantsAdults received venoarterial (VA) or venovenous (VV) ECMO support between November 2017 and April 022.InterventionsNone.Measurements And Main ResultsWe defined 24-hour off sedation as no sedative infusion (except dexmedetomidine) or paralytics administration over a continuous 24-hour period while on ECMO. Off-sedation coma (comaoff) was defined as a Glasgow Coma Scale score of ≤8 after achieving 24-hour off sedation. On-sedation coma (comaon) was defined as a Glasgow Coma Scale score of ≤8 during the entire ECMO course without off sedation for 24 hours. Neurological outcomes were assessed at discharge using the modified Rankin scale (good, 0-3; poor, 4-6). We included 230 patients (VA-ECMO 143, 65% male); 24-hour off sedation was achieved in 32.2% VA-ECMO and 26.4% VV-ECMO patients. Among all patients off sedation for 24 hours (n = 69), 56.5% VA-ECMO and 52.2% VV-ECMO patients experienced comaoff. Among those unable to be sedation free for 24 hours (n = 161), 50.5% VA-ECMO and 17.2% VV-ECMO had comaon. Comaoff was associated with poor outcomes (p < 0.05) in VA-ECMO and VV-ECMO groups, whereas comaon only impacted the VA-ECMO group outcomes. In a multivariable analysis, requirement of renal replacement therapy was an independent risk factor for comaoff after adjusting for ECMO configuration, after adjusting for ECMO configuration, acute brain injury, pre-ECMO partial pressure of oxygen in arterial blood, partial pressure of carbon dioxide in arterial blood, pH, and bicarbonate level (worst value within 24 hours before cannulation).ConclusionsComaoff was common and associated with poor outcomes at discharge. Requirement of renal replacement therapy was an independent risk factor.Copyright © 2024 Elsevier Inc. All rights reserved.

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