Comparison of Neurologic Complications of Veno-arterial Versus Veno-venous Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-analysis (1004)

Objective: We aimed to compare the prevalence of neurologic complications between patients undergoing veno-arterial (VA) and veno-venous (VV) extracorporeal membrane oxygenation (ECMO) Background: Despite a significant increase in the use of ECMO over the last decade, acute brain injury and neurologic complications are common. There has been little research comparing the rate of neurologic complications between VA-ECMO versus VV-ECMO Design/Methods: Following the Preferred Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, we searched PubMed and 6 other databases for observational studies and randomized clinical trials (RCTs) reporting neurologic complications and survival data of adult patients receiving VA- and VV-ECMO. Results: Of 9,056 studies screened, 53 studies met the inclusion criteria including 1 RCT and 52 observational studies. These encompassed 14,977 patients on ECMO, of whom 7,369 (49%) underwent VA-ECMO and 7,608 (51%) underwent VV-ECMO. The median age was 51 years (interquartile range: 44–56) with 9,491 (63%) males. Compared with VV-ECMO patients, VA-ECMO patients had higher prevalence of overall neurologic complications (17% [95% confidence interval (CI) 0.12–0.23] vs 10% [95% CI 0.07–0.15]; p=0.02). Specifically, VA-ECMO patients had higher rates of ischemic stroke (9% [95% CI 0.06 – 0.13] vs 1% [95% CI 0.00–0.03]; p Conclusions: Patients on VA-ECMO support have a higher risk of neurologic injury compared to VV-ECMO. Ischemic stroke, hypoxic ischemic brain injury, and brain death were more common in VA-ECMO patients. The rate of intracranial hemorrhage was similar between VA- and VV-ECMO patients. Disclosure: Dr. Shoskes has nothing to disclose. Dr. Migdady has nothing to disclose. Dr. Deshpande has nothing to disclose. Dr. Price has nothing to disclose. Dr. Hassett has nothing to disclose. Dr. Hernandez has nothing to disclose. Dr. Cho has nothing to disclose.