Comprehensive Summary
This study aimed to develop and validate a prognostic model for predicting intracranial hemorrhage (ICH) in adult patients undergoing extracorporeal membrane oxygenation (ECMO). This retrospective analysis included adult patients who underwent ECMO for more than 24 hours, excluding those with pre-existing ICH prior to ECMO initiation. The primary outcomes were ICH occurrence, in-hospital mortality, and 28-day mortality. Of 227 patients, 22 (9.7%) developed ICH during ECMO support. Patients who developed ICH had significantly higher in-hospital mortality (90.9% vs. 47.8%) and 28-day mortality (81.8% vs. 47.3%) compared with those without ICH. These findings underscore that ICH during ECMO is a strong predictor of mortality, highlighting the need for early identification and risk stratification.
Outcomes and Implications
Although ECMO provides critical cardiac and pulmonary support, it carries a risk of severe complications, with ICH representing the most fatal. ICH detection is often challenging due to patient sedation, neuromuscular blockade, and altered consciousness during ECMO support. Mandatory anticoagulation during ECMO further increases the risk of hemorrhagic complications. These risks underscore the need for a validated predictive model for ICH to enable early identification, guide therapeutic decision-making, and inform the use of interventional strategies.