Factors associated with the development of intracranial hemorrhage in patients treated with extracorporeal membrane oxygenation

Intracranial hemorrhage (ICH) is a major cause of morbidity and mortality during extracorporeal membrane oxygenation (ECMO) and has been associated with prematurity and hypertension. The purpose of this study was to determine whether factors present before the institution of ECMO would predict the development of ICH. Data from the national ECMO registry were collected on all patients who received ECMO over a 2-year period in established centers. Stepwise multivariate analysis was used to determine the relative contribution of different factors in the development of ICH. Data on 972 infants were evaluated; the overall incidence of ICH was 11%. There was a progressive increase in incidence with prematurity, acidosis, and hypercarbia. The best positive predictive value was 60% using all available factors. The premature as well as the term infant with severe metabolic acidosis and hypercarbia has the highest risk to develop ICH on ECMO. Conditions present prior to institution of ECMO therapy have a significant impact on outcome. Although the best predictive ability is only 60%, patients at greatest risk to develop ICH can be identified. Prompt referral and institution of bypass in these patients, when indicated, may modify the subsequent course.