NEUROLOGICAL COMPLICATIONS IN EXTRACORPOREAL MEMBRANE OXYGENATION: RISK FACTORS FOR THE DEVELOPMENT OF ACUTE CEREBROVASCULAR EVENTS

Abstract

Introduction. Cardiovascular diseases remain the leading cause of mortality and disability worldwide, including in Kazakhstan. Extracorporeal membrane oxygenation (ECMO) is a life-saving treatment for severe cardiopulmonary failure; however, its use is associated with a high risk of complications, including acute neurological disorders such as strokes. Objective. To determine the incidence of acute cerebrovascular events (ACE), including ischemic and hemorrhagic strokes, in patients receiving extracorporeal membrane oxygenation (ECMO), as well as to identify key risk factors for their development in the context of clinical practice in Kazakhstan. Methods. A retrospective analysis was conducted on data from 92 patients hospitalized at the Pavlodar Regional Cardiology Center between 2015 and 2024. All patients were on ECMO during the intraoperative or postoperative periods. Study participants were stratified into two cohorts: (1) individuals with acute cerebrovascular events and (2) those without evidence of cerebrovascular compromise. The analysis included an assessment of demographic data, comorbidities, surgical characteristics, and postoperative parameters. The study data were obtained through a retrospective analysis of patients' medical records, including medical histories and electronic databases of the cardiology center. Statistical analysis was performed using IBM™ SPSS 26.0 software (IBM Corporation, Armonk, NY, 2019). Results. Neurological complications, including strokes, were identified in 31.5% of patients on ECMO. The main risk factors were hypertension, smoking, and a history of stroke. It was also found that women and patients with a low left ventricular ejection fraction were at higher risk. The average length of hospitalization for patients with strokes was 30.2 days, which exceeded that of patients without strokes (25.6 days). Conclusion. Strokes remain a significant complication in patients on ECMO, necessitating the development of specific preventive measures. Identified risk factors, such as hypertension, smoking, and a history of stroke, should be considered in the development of clinical guidelines. This study highlights the need for further large-scale research to improve the diagnosis and prevention of strokes in patients on ECMO.