Introduction
Veno-arterial extracorporeal membrane support (VA-ECMO) utilization for
cardiogenic shock has markedly increased in the past few decades, as
technological advances have resulted in equipment improvement and
expanded indications1-4. Etiologies of cardiogenic
shock include, but are not limited to, postcardiotomy shock, acute
myocardial infarction, allogenic graft dysfunction, and acute
decompensated heart failure. Despite successful outcomes in VA-ECMO
deployment, complications are common and mortality rates remain
high5.
Stroke is a major complication with potentially devastating
consequences, including mortality and long-term disability. Reported
stroke incidence during VA-ECMO have ranged from 4.2 - 8% and stroke
remains a leading cause of mortality for patients on
VA-ECMO6-8. The pathophysiology of stroke during ECMO
is complex and suggested to be influenced by several factors, including
cerebral autoregulation, anticoagulation, vasospasm, circuit thrombosis,
and thromboembolism, however specific mechanisms are poorly
understood.9
Arterial cannulation sites for VA-ECMO include ascending aorta, axillary
artery, and femoral artery. There is scarce data about the rates of
stroke according to cannulation site. In older case series of VA-ECMO,
high rates were explained by ligation or cannulation of the internal
carotid, however more contemporary studies continue to document high
rates of stroke despite alternative cannulation sites. The purpose of
this study was to investigate the association between occurrence and
patterns of stroke with ECMO arterial cannulation sites. We hypothesize
that stroke risk would vary with arterial cannulation site.