ECMO Timing and Intracranial Hemorrhage in Coronavirus Patients: Insights for Future Epidemics

Delayed initiation of venovenous extracorporeal membrane oxygenation (VV-ECMO) may increase the risk of intracranial hemorrhage (ICH) in coronavirus patients. This study aimed to investigate the relationship between ECMO timing and the occurrence of ICH in this critically ill population, providing insights for future epidemic management. This retrospective study included coronavirus patients treated with VV-ECMO from March to June 2020. ICH was assessed using head CT scans reviewed by a senior neurosurgeon and neuroradiologist. Among 43 patients (median age: 55 years, 7 women), 19% (n=8) developed ICH during VV-ECMO. In 10 patients, no ICH was detected, and 25 patients had no imaging available. Kaplan-Meier analysis revealed a longer delay from hospital admission to VV-ECMO initiation in patients with ICH (P=0.03). Patients with ICH had lower minute ventilation before cannulation (7.7 L/min vs. 12.1 L/min, P=0.04) and higher arterial lactate levels (3.0 mmol/L vs. 1.9 mmol/L, P=0.03). Elevated serum bilirubin levels were also potentially linked to ICH (P=0.07). Later ECMO initiation, when combined with signs of respiratory and metabolic decompensation, was was associated with a higher risk of ICH in coronavirus patients. These findings emphasize the importance of timely ECMO intervention to reduce ICH risks and inform future epidemic response strategies.