Evidence map›Paper›PMID 37946237›Full record

ArticleCritical care (London, England)2023

Epidemiology of ischemic stroke and hemorrhagic stroke in venoarterial extracorporeal membrane oxygenation.

Jaeho Hwang, Andrew Kalra, Benjamin L Shou, Glenn Whitman, Christopher Wilcox, Daniel Brodie, Akram M Zaaqoq, Roberto Lorusso, Ken Uchino, Sung-Min Cho

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Critical care (London, England), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
24citing papers in PubMed, 6 pooled it
–field-weighted citation impact
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

24 citing papers in PubMed, 6 syntheses or guidelines pooled it.

  1. Pooled it
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  17. Plasma brain-related biomarkers and potential therapeutic targets in pediatric ECMO.Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics · 2025
    Review
  18. Advancing neurocritical care: Bridging molecular mechanisms and physiological monitoring to neurotherapeutics.Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics · 2025
    Article
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors.

Jaeho HwangDepartment of Neurology, The Johns Hopkins Hospital, Baltimore, MD, USA.
Andrew KalraDivision of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
Benjamin L ShouDivision of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
Glenn WhitmanDivision of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
Christopher WilcoxDivision of Critical Care, Department of Medicine, Mercy Hospital of Buffalo, Buffalo, NY, USA.
Daniel BrodieDepartment of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Akram M ZaaqoqDepartment of Anesthesiology, Division of Critical Care, University of Virginia, Charlottesville, VA, USA.
Roberto LorussoCardiothoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.
Ken UchinoCerebrovascular Center, Neurological Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.
Sung-Min ChoDivision of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA. csmfisher@gmail.com.ORCID 0000-0002-5132-0958

Funding

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 K23 HL157610
6 · The paper itself

Abstract

backgroundWhile venoarterial extracorporeal membrane oxygenation (V-A ECMO) provides lifesaving support for cardiopulmonary failure, complications may increase mortality, with few studies focusing on ischemic/hemorrhagic stroke. We aimed to determine the trends and associations of stroke incidence and mortality, and their risk factors, including the effects of annual case volumes of ECMO centers.

methodsRetrospective 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 extracorporeal cardiopulmonary resuscitation. Temporal trend analyses were performed for stroke incidence and mortality. Univariate testing, multivariable regression, and survival analysis were used to evaluate the associations of stroke, 90-day mortality, and impact of annual center volume.

resultsOf 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 PaO

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

Indexed as

Extracorporeal Membrane OxygenationHemorrhagic StrokeIschemic StrokeStrokeAdultHumansIschemiaRegistriesRetrospective StudiesMortalityStrokeTrendVenoarterial ECMO

Identifiers

PMID37946237
PMCPMC10633935

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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.