• Christopher J A Lockie, Stuart A Gillon, Nicholas A Barrett, Daniel Taylor, Asif Mazumder, Kaggere Paramesh, Katie Rowland, Kathleen Daly, and Luigi Camporota.
• 1Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom. 2Department of Critical Care, Queen Elizabeth University Hospital, Glasgow, United Kingdom. 3Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
• Crit. Care Med. 2017 Oct 1; 45 (10): 1642-1649.

ObjectivesFor patients supported with veno-venous extracorporeal membrane oxygenation, the occurrence of intracranial hemorrhage is associated with a high mortality. It is unclear whether intracranial hemorrhage is a consequence of the extracorporeal intervention or of the underlying severe respiratory pathology. In a cohort of patients transferred to a regional severe respiratory failure center that routinely employs admission brain imaging, we sought 1) the prevalence of intracranial hemorrhage; 2) survival and neurologic outcomes; and 3) factors associated with intracranial hemorrhage.DesignA single-center, retrospective, observational cohort study.SettingTertiary referral severe respiratory failure center, university teaching hospital.PatientsPatients admitted between December 2011 and February 2016.InterventionNone.Measurements And Main ResultsThree hundred forty-two patients were identified: 250 managed with extracorporeal support and 92 managed using conventional ventilation. The prevalence of intracranial hemorrhage was 16.4% in extracorporeal membrane oxygenation patients and 7.6% in conventionally managed patients (p = 0.04). Multivariate analysis revealed factors independently associated with intracranial hemorrhage to be duration of ventilation (d) (odds ratio, 1.13 [95% CI, 1.03-1.23]; p = 0.011) and admission fibrinogen (g/L) (odds ratio, 0.73 [0.57-0.91]; p = 0.009); extracorporeal membrane oxygenation was not an independent risk factor (odds ratio, 3.29 [0.96-15.99]; p = 0.088). In patients who received veno-venous extracorporeal membrane oxygenation, there was no significant difference in 6-month survival between patients with and without intracranial hemorrhage (68.3% vs 76.0%; p = 0.350). Good neurologic function was observed in 92%.ConclusionsWe report a higher prevalence of intracranial hemorrhage than has previously been described with high level of neurologically intact survival. Duration of mechanical ventilation and admission fibrinogen, but not exposure to extracorporeal support, are independently associated with intracranial hemorrhage.

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