Female sex decreased risk of composite neurological complications (OR 0.82), while pre-ECMO cardiac arrest (OR 2.53), renal replacement therapy (OR 1.43), and cardiac dysfunction (OR 1.72) increased risk in adult ECMO patients.
Systematic Review (n=62,656)
In adult ECMO patients, factors such as pre-ECMO cardiac arrest, CRRT, cardiac dysfunction, and female sex are significant risk factors for neurological complications, highlighting the need for protocolized neurological monitoring.
Effect estimate: OR 0.82 for female sex; OR 2.53 for pre-ECMO cardiac arrest; OR 1.43 for renal replacement therapy (CRRT); OR 1.72 for cardiac dysfunction (95% CI Female sex: 0.69–0.98; Pre-ECMO cardiac arrest: 2.06–3.10; CRRT: 1.08–1.90; Cardiac dysfunction: 1.15–2.58)
p-value: p=Female sex p=0.03; Pre-ECMO cardiac arrest p<0.001; CRRT p=0.01; Cardiac dysfunction p=0.01
Objective Aiming to systematically review risk factors for neurological complications in adults receiving ECMO support. Methods A comprehensive computerized search was conducted in Chinese and English databases for studies examining risk factors of neurological complications in adult ECMO patients, supplemented by manual and reference tracking, with the search period extending up to April 2025. Meta-analysis and sensitivity analyses were performed using Stata 18.0 software. 29 studies involving 62,656 patients were included. The meta-analysis results showed that female sex, pre-ECMO cardiac arrest, renal replacement therapy, and cardiac insufficiency were influencing factors of composite neurological complications in adult ECMO patients. Female sex and ECMO duration were risk factors of stroke. Female sex, pre-ECMO lactate, pre-ECMO pH, platelet count, low platelets, APTT, and vasoactive drug use were risk factors of intracranial hemorrhage. The pooled results for female sex in the stroke group was not robust. Significant publication bias was observed for composite neurological complications outcomes, whereas no significant publication bias was detected for stroke or intracranial hemorrhage. Conclusion Given the diverse etiologies underlying neurological injury in adult ECMO recipients, protocolized neurological monitoring and prompt intervention for detected abnormalities are strongly recommended. Systematic review registration PROSPERO (CRD420251069285).
Dong et al. (Tue,) conducted a systematic review in Adult patients receiving extracorporeal membrane oxygenation (ECMO) (n=62,656). ECMO support vs. No neurological complications during ECMO was evaluated on Composite neurological complications during or after ECMO support (OR 0.82 for female sex; OR 2.53 for pre-ECMO cardiac arrest; OR 1.43 for renal replacement therapy (CRRT); OR 1.72 for cardiac dysfunction, 95% CI Female sex: 0.69–0.98; Pre-ECMO cardiac arrest: 2.06–3.10; CRRT: 1.08–1.90; Cardiac dysfunction: 1.15–2.58, p=Female sex p=0.03; Pre-ECMO cardiac arrest p<0.001; CRRT p=0.01; Cardiac dysfunction p=0.01). Female sex decreased risk of composite neurological complications (OR 0.82), while pre-ECMO cardiac arrest (OR 2.53), renal replacement therapy (OR 1.43), and cardiac dysfunction (OR 1.72) increased risk in adult ECMO patients.