Focal Neurologic Deficits in Adults After Global Hypoxia-Ischemia and Extracorporeal Membrane Oxygenation
Introduction: Extracorporeal Membrane Oxygenation, or ECMO, provides cardiopulmonary support in critically ill patients with reversible cardiac or respiratory disease processes. Neurologic sequelae after ECMO have been well-studied in infants, but have not been evaluated in adults. We investigated the incidence of focal neurologic deficits in adults after global hypoxia-ischemia and ECMO as reported by the survivors or as seen on physical examination of the survivors. Methods: We performed a retrospective analysis of all adult patients who received ECMO urgently between 12/95 and 1/99. Fifty-nine percent of the survivors were contacted to participate in a telephone survey regarding neurologic symptoms and quality of life measures, including a Barthel Index. One survivor declined to participate. Results: During the time period of 12/95 to 1/99, 86 adult patients received ECMO urgently at the University of Michigan, 42 patients survived the hospitalization, and 44 patients died. Of the 42 survivors, 7 were lost to followup, and 8 died at a later date, with a mean length of survival after the ECMO hospitalization of 17 months. The mean age of the ECMO survivors was 38 (18–72), racial distribution was 66% white, 27% black, and 7% unknown or other. The survivors were 58% male and 42% female. Underlying diagnoses requiring ECMO support were 85% respiratory, and 15% cardiac. Average length of followup was 36.5 months. Of those contacted, 39% reported at least one neurologic symptom, moderately to severely disabling, that was new since the hospitalization during which ECMO occurred. Those symptoms are as follows: 13% unilateral weakness in face and/or body, 13% difficulty with language, 17% difficulty walking, and 9% blurred or double vision. All patients reported a completely independent Barthel Index score. Conclusions: A significant proportion of adult survivors of global hypoxia-ischemia and ECMO report neurologic deficits that are at least moderately disabling which are new since receiving ECMO. Of these deficits, problems with ambulation were the most common. Physical examinations are planned to further investigate these findings.