Background

While venoarterial extracorporeal membrane oxygenation (V‑A ECMO) provides lifesaving supportfor cardiopulmonary failure, complications may increase mortality, with few studies focusing on ischemic/hemor‑rhagic stroke. We aimed to determine the trends and associations of stroke incidence and mortality, and their riskfactors, including the effects of annual case volumes of ECMO centers.

Methods

Retrospective analysis was performed on the Extracorporeal Life Support Organization (ELSO) registry,including adult V‑A ECMO patients from 534 international centers between 2012 and 2021, excluding extracorporealcardiopulmonary resuscitation. Temporal trend analyses were performed for stroke incidence and mortality. Univariatetesting, multivariable regression, and survival analysis were used to evaluate the associations of stroke, 90‑day mortal‑ity, and impact of annual center volume.

Results

Of 33,041 patients, 20,297 had mortality data, and 12,327 were included in the logistic regression. Between 2012 and 2021, ischemic stroke incidence increased (p < 0.0001), hemorrhagic stroke incidence remained stable,and overall 90‑day mortality declined (p < 0.0001). Higher 24‑h PaO2 and greater decrease between pre‑ECMOPaCO2 and post‑cannulation 24‑h PaCO2 were associated with greater ischemic stroke incidence, while annual casevolume was not. Ischemic/hemorrhagic strokes were associated with increased 90‑day mortality (both p < 0.0001),while higher annual case volume was associated with lower 90‑day mortality (p = 0.001). Hazard of death was highestin the first several days of V‑A ECMO.

Conclusion

In V‑A ECMO patients between 2012 and 2021, 90‑day mortality decreased, while ischemic strokeincidence increased. ELSO centers with higher annual case volumes had lower mortality, but were not associatedwith ischemic/hemorrhagic stroke incidence. Both ischemic/hemorrhagic strokes were associated with increasedmortality.