Risk factors for intracranial hemorrhage in adults on extracorporeal membrane oxygenation

Objective. Intracranial hemorrhage is a recognized complication in neonates and infants on extracorporeal membrane oxygenator support and various risk factors associated with this have been defined. The prevalence and risk fa ctors associated with intracranial hemorrhage in adults on extracorporeal m embrane oxygenator support are unknown and this study was performed to defi ne these factors. Methods. A retrospective study of adults supported with e xtracorporeal membrane oxygenators at a single institution between January 1992 and December 1996 was performed. Age, gender, weight, body surface are a, renal function, anticoagulation, coagulation variables, blood Raw, arter ial pressure, arterial cannulation sites, duration of support, extracranial bleeding, native cardiac function and presence of intracranial microemboli were analyzed to determine the risk factors for intracranial hemorrhage. R esults. Fourteen out of 74 adults on extracorporeal membrane oxygenator sup port had intracranial hemorrhage (18.9%). An increased risk of intracranial hemorrhage showed a positive correlation with female gender (P = 0.02, odd s ratio 6.5), use of heparin (P = 0.05, odds ratio 8.5), creatinine greater than 2.6 mg/ dl (P = 0.009, odds ratio 6.5), need For dialysis (P = 0.03, odds ratio 4.3) and thrombocytopenia (P = 0.007, odds ratio 18.3). Diminish ing renal function and the need for dialysis were associated with increasin g duration of support. Multivariable logistic regression showed female gend er and thrombocytopenia, especially with platelet counts less than 50 000 c ells/mm(3) to be the most important predictors of intracranial hemorrhage. Intracranial hemorrhage was associated with a mortality of 92.3% compared w ith a mortality of 61% in those without intracranial hemorrhage (P = 0.027) . Conclusion. Intracranial hemorrhage is a significant complication in adul ts on extracorporeal membrane oxygenator support. Judicious management of a nticoagulation, prevention of renal failure and aggressive correction of th rombocytopenia may help to lower the risk of intracranial hemorrhage in adu lts on extracorporeal membrane oxygenator support. (C) 1999 Elsevier Scienc e B.V, All rights reserved.