To investigate the incidence and nature of adverse neurological events in patients undergoing ECMO at a tertiary care academic institution.

We prospectively followed patients undergoing ECMO at our institution from 1/2017-2/2019. 93 patients were followed (VA-ECMO-84 vs VV-ECMO-9). An adverse neurological event was defined as findings of Hypoxic ischemic encephalopathy, Acute ischemic stroke (AIS), Intraparenchymal hemorrhage, Subarachnoid hemorrhage or Subdural hemorrhage on CT head.

During the study period about 27% of the patients had an adverse neurological event. Ischemic events (20%) were found to be more common than hemorrhagic events (7%). An acute ischemic stroke (AIS) was the most common adverse outcome and occurred in 18% of the population followed by intraparenchymal hemorrhage in 4%, Subarachnoid hemorrhage in 2%, Hypoxic ischemic encephalopathy in 2% and Subdural hemorrhage in 1%.

Patient who had an adverse neurological outcome did not have significantly worse mortality at the time of discharge (77.3% vs 58.2%, P-Value=0.11). Survival at 30 days (22.7% vs 40.9%, P-Value=0.13) and at 365 days post discharge (27.3% vs 35.5%, P-Value=0.48) was also not significantly different for those having an adverse neurologic event.

All the neurologic adverse events occurred in patients undergoing VA-ECMO and no adverse events were recorded in the VV-ECMO patients.  

The rate of adverse events was not different when comparing a central to a peripheral cannulation site (26% vs 29%, P-value- 0.35).

Our study re demonstrates the high rates of adverse neurologic events in patients undergoing ECMO though in our study it did not appear to impact mortality significantly.

All our neurologic adverse events occurred in VA-ECMO patients though our sample of VV- ECMO patients was very small and hence inferences are limited.