Survival rates, outcomes favorable for those given ECMO with neurosurgical intervention

Key takeaways:

• The study analyzed 24 individuals hospitalized for neurologic procedures who underwent ECMO.
• Survival-to-discharge rate was similar to the rate in the Extracorporeal Life Support Organization registry.

DENVER —Extracorporeal membrane oxygenation therapy led to favorable survival and neurologic outcomes for patients who required neurosurgical intervention, according to a poster at the American Academy of Neurology annual meeting.

“We wanted to look at patients that underwent neurosurgical interventions either before or during [extracorporeal membrane oxygenation], as it’s usually a contraindication,” Samantha Marie Helmy, BA, from the University of Rochester School of Medicine and Dentistry, told Healio. “

Helmy and colleagues conducted a retrospective chart review of adults who required extracorporeal membrane oxygenation (ECMO) from four different institutions (University of Rochester Medical Center, University of Maryland Medical Center, Johns Hopkins Hospital, University of Virginia Medical Center) from 2015 to 2023. Included patients underwent neurosurgery during or before ECMO therapy during hospitalization.

A total of 24 individuals (mean age 40.9 years; 88% male) were included for analysis, with an even split among those who underwent veno-venous or veno-arterial ECMO.

The primary outcome was survival to hospital discharge, while the main secondary outcome was survival to discharge with good neurologic outcome as measured by the Cerebral Performance Category (CPC) score, with 1 to 2 being favorable and 3 to 5 being unfavorable.

Neurosurgery was performed during ECMO in 11 patients while the remainder occurred prior to ECMO. Fifteen patients survived discharge, 12 of whom departed with a favorable neurologic outcome (CPC score of 1 to 2), the researchers wrote.

Data further showed the survival-to-discharge rate was similar between those who had neurosurgical procedures performed while on ECMO (seven of 11, 63%) and prior to ECMO (eight of 13, 62%). ECMO-related complications occurred in 17 of 24 (62.9%) patients while three others experienced a surgery-related complication. The cohort recorded a similar survival to discharge compared to those from the Extracorporeal Life Support Organization registry (53.3%) between 2018 and 2022.

“For the patients we found across four different institutions, they had favorable neurological outcomes compared to those on ECMO without any neurosurgical intervention,” Helmy said.