ID:80 FC-D04-10 Clinical characteristics of patients who developed ischemic stroke during VA-ECMO support

Background: Ischemic stroke is a serious complication of venoarterial extracorporeal membrane oxygenation (VA-ECMO) and is associated with poor clinical outcomes. However, the epidemiology, characteristics, and outcomes in this population remain unclear. We aimed to describe these findings among patients who developed ischemic stroke during VA-ECMO. Methods: We conducted a single-center retrospective observational study of patients who received VA-ECMO from 2019 to 2025. Patients without brain imaging (CT/MRI) or those with severe hypoxic–ischemic brain injury were excluded. Clinical data during VA-ECMO support were collected and compared between patients with and without ischemic stroke. Results: Of 116 patients who received VA-ECMO, 58 were eligible for this analysis, and 21 (36%) developed ischemic stroke. Infarcts most frequently involved the posterior circulation area (76%), followed by watershed territories (38%) and other territories (19%). Compared with patients without ischemic stroke, those with ischemic stroke had a higher prevalence of diabetes mellitus (p=0.05), dyslipidemia (p=0.03), a higher proportion of vasopressor administration during VA-ECMO (p=0.02) and a higher incidence of hypotension during VA-ECMO (mean arterial pressure <60 mmHg; p<0.01). There are significant differences in lactate levels and VA-ECMO duration between the two groups (p=0.03 and p=0.01, respectively). Conclusion: Patients who developed ischemic stroke during VA-ECMO experienced hemodynamic instability frequently compared with those without ischemic stroke, and infarcts predominantly occurred in the posterior circulation area and watershed territories. These findings suggest that hypoperfusion related to circulatory failure may contribute to ischemic stroke during VA-ECMO.