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.