Evidence map›Paper›PMID 36628944›Full record

ArticleInnovations (Philadelphia, Pa.)

Management of Anticoagulation Therapy in ECMO-Associated Ischemic Stroke and Intracranial Hemorrhage.

Rochelle Prokupets, Nivedha Kannapadi, Henry Chang, Giorgio Caturegli, Errol L Bush, Bo Soo Kim, Steven Keller, Romergryko G Geocadin, Glenn J R Whitman, Sung-Min Cho and 1 more

Open access · greenAbstract read

PubMed Full text at PMC Publisher

In one paragraph

Article in Innovations (Philadelphia, Pa.). The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it

0cells of the map it votes in

8citing papers in PubMed, 1 pooled it

3.0field-weighted citation impact, top 8% of its field

1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 1 synthesis or guideline pooled it, 14 citations in OpenAlex.

Neurological Monitoring and Management for Adult Extracorporeal Membrane Oxygenation Patients: Extracorporeal Life Support Organization Consensus Guidelines.ASAIO journal (American Society for Artificial Internal Organs : 1992) · 2024
Guideline
Lessons Learned: Earliest Possible Therapeutic Anticoagulation after Cranial Surgery.Neurocritical care · 2026
Article
Balancing thrombosis and hemorrhage: anticoagulation-free VA-ECMO with a multidisciplinary strategy for cerebellar hemorrhage complicated by takotsubo syndrome.BMC anesthesiology · 2025
Article
ECMO and impella increase stroke risk in acute myocardial infarction.Scientific reports · 2025
Article
Cerebrovascular Strokes During Venoarterial Extracorporeal Membrane Oxygenation.Critical care research and practice · 2025
Article
Clinical Use of Bedside Portable Ultra-Low-Field Brain Magnetic Resonance Imaging in Patients on Extracorporeal Membrane Oxygenation: Results From the Multicenter SAFE MRI ECMO Study.Circulation · 2024
Observational
Acute Ischemic Stroke during Extracorporeal Membrane Oxygenation (ECMO): A Narrative Review of the Literature.Journal of clinical medicine · 2024
Review
Neurological monitoring and management for adult extracorporeal membrane oxygenation patients: Extracorporeal Life Support Organization consensus guidelines.Critical care (London, England) · 2024
Review

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 1 institution in 1 country.

Rochelle ProkupetsNeuroscience Critical Care Division, Departments of Neurology, Neurosurgery, and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Nivedha KannapadiNeuroscience Critical Care Division, Departments of Neurology, Neurosurgery, and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Henry ChangNeuroscience Critical Care Division, Departments of Neurology, Neurosurgery, and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Giorgio CaturegliNeuroscience Critical Care Division, Departments of Neurology, Neurosurgery, and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Errol L BushDivision of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Bo Soo KimDivision of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Steven KellerDivision of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Romergryko G GeocadinNeuroscience Critical Care Division, Departments of Neurology, Neurosurgery, and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Glenn J R WhitmanDivision of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Sung-Min ChoNeuroscience Critical Care Division, Departments of Neurology, Neurosurgery, and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.ORCID 0000-0002-5132-0958

HERALD Investigators

Johns Hopkins University · US

Funding

Functional restoration of ventriculo-arterial coupling in cardiogenic shock via dual mechanical supportK08HL143342 · NHLBI · JOHNS HOPKINS UNIVERSITY · PI KELLER, STEVEN PAUL · 2018 to 2023

$853k

CLots and Oxygen in Va-ExtracorpoReal membrane oxygenation (CLOVER) studyK23HL157610 · NHLBI · JOHNS HOPKINS UNIVERSITY · PI Sung-Min Cho · 2022 to 2026

$797k

NHLBI NIH HHS K08 HL143342NHLBI NIH HHS K23 HL157610NHLBI NIH HHS L30 HL165486

6 · The paper itself

Abstract

objectiveDespite the common occurrence of extracorporeal membrane oxygenation (ECMO)-associated acute ischemic stroke (AIS) and intracranial hemorrhage (ICH), there are little data to guide optimal anticoagulation management. We sought to describe antithrombotic therapy management after stroke and outcomes.

methodsA retrospective analysis was conducted of venoarterial (VA) and venovenous (VV) ECMO patients treated at a tertiary care center from June 2016 to February 2021. Patients with image-confirmed diagnosis of AIS or ICH while receiving ECMO were included for study with data collected regarding anticoagulation management and clinical outcomes.

resultsOverall, 216 patients (153 VA-ECMO, 63 VV-ECMO) were included in this study. Of the 153 patients on VA-ECMO, 13 (8.4%) had AIS and 6 (3.9%) had ICH. Of the 63 patients on VV-ECMO, none had AIS and 5 (7.9%) had ICH. One patient (9%) received anticoagulation reversal after ICH. Anticoagulation was discontinued and later resumed in all 5 ICH survivors (median cessation time, 30 h) and 1 of 2 (50%) AIS survivors (median cessation time, 96 h). While off anticoagulation, 2 of 11 patients (18%) had thromboembolic events and none had new AIS. Upon resumption, there were no cases of hemorrhagic transformation of AIS or ICH expansion. There was no difference in in-hospital mortality between patients with ICH and those without in both the VA-ECMO and VV-ECMO cohorts nor between VA-ECMO patients with AIS and those without.

conclusionsEarly cessation and judicious resumption of anticoagulation appeared feasible in the cohort of patients with ECMO-associated AIS and ICH.

Indexed as

Extracorporeal Membrane OxygenationIschemic StrokeAnticoagulantsHumansIntracranial HemorrhagesRetrospective StudiesAnticoagulantsanticoagulationECMOstroke

Identifiers

PMID36628944

DOI10.1177/15569845221141702

PMCPMC10236353

OpenAlexW4315566672

What OpenQuestion holds

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LicenceTDM

Read underepoch 390

Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.