Incidence and impact of intracranial complications in patients undergoing extracorporeal membrane oxygenation treatment.

Authors

Jan Wiefhoff, Friedrich Thomas Irmer, Felix Maximilian Gerach, Jan Rodemerk, Ramazan Jabbarli, Marvin Darkwah Oppong, Cornelius Deuschl, Börge Schmidt, Frank Herbstreit, Thorsten Brenner, Ulrich Sure, Laurèl Rauschenbach

Published in

Brain & spine. Volume 6. Pages 106123. Epub Jun 11, 2026.

Abstract

Extracorporeal membrane oxygenation (ECMO) is a life-saving intervention for respiratory and/or cardiac failure but is associated with high morbidity and mortality, particularly due to intracranial complications.
What is the incidence, type, and impact of intracranial complications in patients undergoing ECMO treatment?
This retrospective single-center study included ECMO patients treated at a tertiary care center between 2013 and 2023. Patients with documented intracranial hemorrhage, cerebral ischemic stroke, or diffuse hypoxic cerebral edema were included. Demographic, clinical, radiological, and outcome data were analyzed.
Among 775 ECMO patients, 141 (18%) developed intracranial complications, including intracerebral hemorrhage (36%), subarachnoid hemorrhage (22%), diffuse hypoxic cerebral edema (25%), ischemic stroke (14%), and subdural hematoma (4%). Secondary deterioration (p = 0.009), midline shift (p = 0.005), and pupillary abnormalities (p < 0.001), were associated with in-hospital mortality, though only pupillary abnormalities remained significant in multivariate analysis (p = 0.006). Patients with diffuse hypoxic cerebral edema were younger (p < 0.001), had lower multimorbidity (p = 0.019, p < 0.001) and disease burden (p = 0.02, p = 0.011), and showed less secondary deterioration (p < 0.001) than those with bleeding or ischemic stroke. In-hospital mortality was higher in patients with intracranial complications (77%) compared to those without (59%, p < 0.001). Most survivors revealed severe disability, with a median modified Rankin Scale score of 5 at discharge.
Acute intracranial complications in patients undergoing ECMO are frequent, heterogeneous in presentation, and associated with poor outcomes. Pupillary abnormalities emerged as the strongest predictor of mortality. Early identification of high-risk patients may facilitate targeted monitoring and timely interventions to improve outcomes.

PMID:
42382653
Bibliographic data and abstract were imported from PubMed on 01 Jul 2026.

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